Provider Demographics
NPI:1710235619
Name:BHAKHRI, JILL (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:BHAKHRI
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 1:1235 W TOWN AND COUNTRY RD
Mailing Address - Street 2:APARTMENT 1402
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4611
Mailing Address - Country:US
Mailing Address - Phone:847-790-2565
Mailing Address - Fax:
Practice Address - Street 1:16803 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-9242
Practice Address - Country:US
Practice Address - Phone:909-349-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010610152W00000X
CA14548152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist