Provider Demographics
NPI:1447456827
Name:VIRK, SANJEET KAUR (OD)
Entity type:Individual
Prefix:DR
First Name:SANJEET
Middle Name:KAUR
Last Name:VIRK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SANJEET
Other - Middle Name:KAUR
Other - Last Name:SHAHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2602 GILSOM CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6154
Mailing Address - Country:US
Mailing Address - Phone:407-952-9681
Mailing Address - Fax:
Practice Address - Street 1:619 S MARION AVE (LAKE CITY VAMC)
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist