MEDICARE: DR. HEMALI BHAKTA JARDOSH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618002186	VA
2	152W00000X	Optometrist	21424-875	WI
3	152W00000X	Optometrist	TA2328	MD
4	152W00000X	Optometrist	14065	CA

General Provider Information

NPI Number	:	1144537218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEMALI BHAKTA JARDOSH O.D.

Provider Business Mailing Address
First Line	:	8016 PRIVET LN
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90241-6011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 LAKEWOOD CENTER MALL
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2409
Country	:	US
Telephone Number	:	562-602-6100
Fax Number	:	562-295-1520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	03/02/2026

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