Provider Demographics
NPI:1750687000
Name:GREWAL, DEVINDER KAUR (OD)
Entity Type:Individual
Prefix:
First Name:DEVINDER
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 1:255 E WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2706
Mailing Address - Country:US
Mailing Address - Phone:209-466-5566
Mailing Address - Fax:209-466-0535
Practice Address - Street 1:255 E WEBER AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2706
Practice Address - Country:US
Practice Address - Phone:209-466-5566
Practice Address - Fax:209-466-0535
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT14096TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAET627VMedicare PIN
CAET627YMedicare PIN
CAET627ZMedicare PIN
CAET627UMedicare PIN
CAET627XMedicare PIN
CAET627WMedicare PIN