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General NPI Number Information
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NPI Number | 1780912170
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Entity Type | Individual
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Provider Name | JASDEEP SIDHU O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 27101 PIONEER HWY
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City | STANWOOD
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State | WA
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Zip | 98292-6057
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Country | US
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Telephone | 360-629-9535
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Fax |
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Provider Business Mailing Address
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Address Line | 5801 SUMMITVIEW AVE
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City | YAKIMA
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State | WA
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Zip | 98908-3006
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Country | US
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Telephone | 509-965-6405
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Fax |
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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 | OD60109766
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License Number State | WA
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