Provider Demographics
NPI:1003997131
Name:JAGLAN, PARVEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:PARVEEN
Middle Name:
Last Name:JAGLAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PARVEEN
Other - Middle Name:
Other - Last Name:JAGLAN-SHARMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2430 HERODIAN WAY SE
Mailing Address - Street 2:STE.200
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2980
Mailing Address - Country:US
Mailing Address - Phone:770-953-9000
Mailing Address - Fax:770-953-1553
Practice Address - Street 1:2430 HERODIAN WAY SE
Practice Address - Street 2:STE.200
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2980
Practice Address - Country:US
Practice Address - Phone:770-953-9000
Practice Address - Fax:770-953-1553
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002154OtherLICENSE NUMBER