Provider Demographics
NPI:1194845206
Name:DHALIWAL, INDERJIT K (OD)
Entity Type:Individual
Prefix:DR
First Name:INDERJIT
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 1:5951 N SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8111
Mailing Address - Country:US
Mailing Address - Phone:559-277-1785
Mailing Address - Fax:559-277-1036
Practice Address - Street 1:3680 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3231
Practice Address - Country:US
Practice Address - Phone:559-277-1785
Practice Address - Fax:559-277-1036
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA013142T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist