Provider Demographics
NPI:1114072485
Name:SHERGILL, TAJINDER KAUR (OD)
Entity Type:Individual
Prefix:DR
First Name:TAJINDER
Middle Name:KAUR
Last Name:SHERGILL
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 1:3500 S MERIDIAN
Mailing Address - Street 2:#345
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3779
Mailing Address - Country:US
Mailing Address - Phone:253-848-9620
Mailing Address - Fax:253-840-8536
Practice Address - Street 1:3500 S MERIDIAN
Practice Address - Street 2:#345
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3779
Practice Address - Country:US
Practice Address - Phone:253-848-9620
Practice Address - Fax:253-840-8536
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3309TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU70338Medicare UPIN
WAABO3966Medicare ID - Type Unspecified