Provider Demographics
NPI:1780447672
Name:TOOR, PREET (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:PREET
Middle Name:
Last Name:TOOR
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 W JACK LONDON BLVD # C3
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7609
Mailing Address - Country:US
Mailing Address - Phone:602-717-6907
Mailing Address - Fax:925-800-5751
Practice Address - Street 1:3024 W JACK LONDON BLVD # C3
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7609
Practice Address - Country:US
Practice Address - Phone:925-800-5149
Practice Address - Fax:925-800-5751
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180240-CLD9013156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93-1390941OtherVSP