Healthcare Provider Details

I. General information

NPI: 1366173718
Provider Name (Legal Business Name): LAKSHMISAHITHI RANI JAEEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RANI JAEEL

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 ILLINOIS STREET
SAN FRANCISCO CA
94158
US

IV. Provider business mailing address

595 DEAN ST APT 104
BROOKLYN NY
11238-7479
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2800
  • Fax:
Mailing address:
  • Phone: 909-755-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36173
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number9638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: