Provider Demographics
NPI:1821275207
Name:AMANDIP SINGH SAPPAL, O.D., P.A.
Entity Type:Organization
Organization Name:AMANDIP SINGH SAPPAL, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDIP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SAPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-252-8885
Mailing Address - Street 1:15651 SHERIDAN ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3496
Mailing Address - Country:US
Mailing Address - Phone:954-252-8885
Mailing Address - Fax:
Practice Address - Street 1:15651 SHERIDAN ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-3496
Practice Address - Country:US
Practice Address - Phone:954-252-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3739152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV00420Medicare UPIN
FLK5963Medicare PIN