Provider Demographics
NPI:1841863644
Name:VAYALIL, JESLYN (OD)
Entity type:Individual
Prefix:DR
First Name:JESLYN
Middle Name:
Last Name:VAYALIL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JESLYN
Other - Middle Name:
Other - Last Name:VAYALIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JESLYN VAYALIL, OD
Mailing Address - Street 1:9127 W THUNDERBIRD RD STE I104
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4887
Mailing Address - Country:US
Mailing Address - Phone:623-972-2158
Mailing Address - Fax:623-972-3625
Practice Address - Street 1:9127 W THUNDERBIRD RD STE I104
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4887
Practice Address - Country:US
Practice Address - Phone:623-972-2158
Practice Address - Fax:623-972-3625
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist