Provider Demographics
NPI:1760736680
Name:MANN, JASMEET KAUR (OD)
Entity Type:Individual
Prefix:MRS
First Name:JASMEET
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-0186
Mailing Address - Country:US
Mailing Address - Phone:209-537-8971
Mailing Address - Fax:209-537-8974
Practice Address - Street 1:1901 MITCHELL RD STE C
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307
Practice Address - Country:US
Practice Address - Phone:209-537-8971
Practice Address - Fax:209-537-8974
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14549152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5033839Medicaid
CADB428AOtherMEDICARE GROUP PTAN
CA5033839Medicaid
CAP01292561Medicare PIN