Provider Demographics
NPI:1598381543
Name:PUREWAL, AVNEET (OD)
Entity Type:Individual
Prefix:DR
First Name:AVNEET
Middle Name:
Last Name:PUREWAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14-23330 TOWNSHIP ROAD 522
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD PARK
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T8B1H8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 N GREEN VALLEY PKWY STE 420
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6172
Practice Address - Country:US
Practice Address - Phone:312-358-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist