Provider Demographics
NPI:1689708448
Name:MANN, SURBJEET KAUR (OD)
Entity Type:Individual
Prefix:DR
First Name:SURBJEET
Middle Name:KAUR
Last Name:MANN
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 1:6920 W ROBINWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93723-4005
Mailing Address - Country:US
Mailing Address - Phone:559-274-8007
Mailing Address - Fax:559-447-4994
Practice Address - Street 1:5478 N PALM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1940
Practice Address - Country:US
Practice Address - Phone:559-447-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13090T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist