Provider Demographics
NPI:1902908791
Name:DHALIWAL, AMRITA K (OD)
Entity Type:Individual
Prefix:DR
First Name:AMRITA
Middle Name:K
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 E SPEER BLVD APT 634
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3576
Mailing Address - Country:US
Mailing Address - Phone:612-232-3787
Mailing Address - Fax:
Practice Address - Street 1:10001 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2050
Practice Address - Country:US
Practice Address - Phone:303-451-8075
Practice Address - Fax:303-457-9859
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1044035OtherAMERICA'S PPO
MN2203199OtherMEDICA/UNITED HEALTH CARE
MN183M2PEOtherBCBS/MN
MN799167300Medicaid
MNMN3006OtherEYEMED
MN185171045937OtherPREFERRED ONE
MNMN3006OtherEYEMED
MNV07968Medicare UPIN
MN183M2PEOtherBCBS/MN