Provider Demographics
NPI:1790110963
Name:JANICE KASSAWAT, O.D. INC.
Entity Type:Organization
Organization Name:JANICE KASSAWAT, O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-444-4225
Mailing Address - Street 1:17900 NEWHOPE ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5422
Mailing Address - Country:US
Mailing Address - Phone:714-444-4225
Mailing Address - Fax:714-444-4225
Practice Address - Street 1:17900 NEWHOPE ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5422
Practice Address - Country:US
Practice Address - Phone:714-444-4225
Practice Address - Fax:714-444-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9721 T G152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty