Healthcare Provider Details

I. General information

NPI: 1285043943
Provider Name (Legal Business Name): JASLEEN KAUR JHAJJ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3241 S MICHIGAN AVE
CHICAGO IL
60616-3878
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4200
  • Fax:
Mailing address:
  • Phone: 312-225-6200
  • Fax: 312-949-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number046010827
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010827
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: