Provider Demographics
NPI:1548028699
Name:OPTOM SPOT PC
Entity type:Organization
Organization Name:OPTOM SPOT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OD
Authorized Official - Prefix:
Authorized Official - First Name:SHIKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-529-9964
Mailing Address - Street 1:903 20TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1311
Mailing Address - Country:US
Mailing Address - Phone:612-338-7551
Mailing Address - Fax:612-338-7403
Practice Address - Street 1:903 20TH AVE N
Practice Address - Street 2:
Practice Address - City:SOUTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-1311
Practice Address - Country:US
Practice Address - Phone:612-338-7551
Practice Address - Fax:612-338-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty