Provider Demographics
NPI:1881002830
Name:PANESAR, JASVEEN K (OD)
Entity Type:Individual
Prefix:
First Name:JASVEEN
Middle Name:K
Last Name:PANESAR
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 1:520 W STATE ROAD 436
Mailing Address - Street 2:#1130
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4045
Mailing Address - Country:US
Mailing Address - Phone:407-788-3636
Mailing Address - Fax:
Practice Address - Street 1:520 W STATE ROAD 436
Practice Address - Street 2:#1130
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4045
Practice Address - Country:US
Practice Address - Phone:407-788-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist