Provider Demographics
NPI:1891759296
Name:SINGH, KANCHAN P (OD)
Entity Type:Individual
Prefix:DR
First Name:KANCHAN
Middle Name:P
Last Name:SINGH
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 1:2921 ERIE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:609 COLUMBIA TURNPIKE
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061
Practice Address - Country:US
Practice Address - Phone:518-477-8700
Practice Address - Fax:518-477-8703
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT0033001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB1101Medicare PIN
NYRB0325Medicare PIN
NYRB0322Medicare PIN
U06663Medicare UPIN
NYDD3953Medicare ID - Type Unspecified
NYRB0324Medicare PIN