Provider Demographics
NPI:1205424942
Name:GURJEET KAILA
Entity type:Organization
Organization Name:GURJEET KAILA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GURJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:KAILA
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRY DOCTOR
Authorized Official - Phone:559-908-6083
Mailing Address - Street 1:511 E KERN AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4210
Mailing Address - Country:US
Mailing Address - Phone:559-688-0661
Mailing Address - Fax:559-688-9210
Practice Address - Street 1:511 E KERN AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4210
Practice Address - Country:US
Practice Address - Phone:559-688-0661
Practice Address - Fax:559-688-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386831097Medicaid