Provider Demographics
NPI:1619590924
Name:SRAN, AKIRTA KOUR (OD)
Entity Type:Individual
Prefix:
First Name:AKIRTA
Middle Name:KOUR
Last Name:SRAN
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 1:5233 22 STREET
Mailing Address - Street 2:
Mailing Address - City:LLOYDMINSTER
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T9V3G4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:541 W BACON ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3917
Practice Address - Country:US
Practice Address - Phone:570-628-3937
Practice Address - Fax:570-622-2795
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOEG003721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program