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General NPI Number Information
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NPI Number | 1366165094
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Entity Type | Individual
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Provider Name | JEREDINE M KALLON OD
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 14 CONSULTANT PL STE 100
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City | DURHAM
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State | NC
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Zip | 27707-6326
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Country | US
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Telephone | 919-493-3668
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Fax | 919-490-5594
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Provider Business Mailing Address
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Address Line | PO BOX 208869
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City | DALLAS
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State | TX
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Zip | 75320-8869
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Country | US
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Telephone | 636-200-4393
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Fax | 636-527-0766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2812
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License Number State | NC
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