Provider Demographics
NPI:1457824724
Name:JASLEEN KAUR LLC
Entity Type:Organization
Organization Name:JASLEEN KAUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JASLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-326-0747
Mailing Address - Street 1:3440 AVALON RD APT 104
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3755
Mailing Address - Country:US
Mailing Address - Phone:925-326-0747
Mailing Address - Fax:
Practice Address - Street 1:14070 CEDAR RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3216
Practice Address - Country:US
Practice Address - Phone:216-297-9492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1205357662OtherMEDICARE