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General NPI Number Information
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NPI Number | 1790110963
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Entity Type | Organization
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Legal Business Name | JANICE KASSAWAT, O.D. INC.
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 17900 NEWHOPE ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5422
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Country | US
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Telephone | 714-444-4225
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Fax | 714-444-4225
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Provider Business Mailing Address
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Address Line | 17900 NEWHOPE ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5422
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Country | US
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Telephone | 714-444-4225
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Fax | 714-444-4225
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JANICE KASSAWAT
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Credential | O.D.
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Telephone | 714-444-4225
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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 | 9721 T G
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License Number State | CA
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