Provider Demographics
NPI:1376295808
Name:GREWAL, JASKIRAN KAUR (OD)
Entity Type:Individual
Prefix:DR
First Name:JASKIRAN
Middle Name:KAUR
Last Name:GREWAL
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 1:6323 COUNTY ROAD 18
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-9473
Mailing Address - Country:US
Mailing Address - Phone:530-518-4223
Mailing Address - Fax:
Practice Address - Street 1:715 JACKSON ST STE A
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3771
Practice Address - Country:US
Practice Address - Phone:530-527-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist