Healthcare Provider Details

I. General information

NPI: 1386261964
Provider Name (Legal Business Name): HARJAS S AULAKH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 141 AVENUE NW
EDMONTON ALBERTA
T5A4R5
CA

IV. Provider business mailing address

3549 SILVERSIDE RD # E403
WILMINGTON DE
19810-4922
US

V. Phone/Fax

Practice location:
  • Phone: 780-220-3530
  • Fax:
Mailing address:
  • Phone: 724-579-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTPOP104
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009690
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003704
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: