Provider Demographics
NPI:1912196593
Name:SHETH, PURVIKA MILAN (OD)
Entity Type:Individual
Prefix:DR
First Name:PURVIKA
Middle Name:MILAN
Last Name:SHETH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PURVIKA
Other - Middle Name:JITENDRA
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:36 ARDEN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1503
Mailing Address - Country:US
Mailing Address - Phone:973-588-4205
Mailing Address - Fax:
Practice Address - Street 1:245 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-4629
Practice Address - Country:US
Practice Address - Phone:973-785-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00588000152W00000X
NYTUV0066731152W00000X
PAOEG001464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U99205Medicare UPIN