Provider Demographics
NPI:1609840024
Name:SABHERWAL, RAVINDER S (OD)
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:S
Last Name:SABHERWAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 ZUCK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3151
Mailing Address - Country:US
Mailing Address - Phone:814-838-9555
Mailing Address - Fax:814-835-7776
Practice Address - Street 1:2640 ZUCK RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3151
Practice Address - Country:US
Practice Address - Phone:814-838-9555
Practice Address - Fax:814-835-7776
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010530090003Medicaid
PAT30405Medicare UPIN
PA0010530090003Medicaid