Provider Demographics
NPI:1205357662
Name:KAUR, JASLEEN (OD)
Entity Type:Individual
Prefix:
First Name:JASLEEN
Middle Name:
Last Name:KAUR
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-0490
Mailing Address - Country:US
Mailing Address - Phone:440-975-8200
Mailing Address - Fax:
Practice Address - Street 1:6879B SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3608
Practice Address - Country:US
Practice Address - Phone:440-975-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEP008569152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist