Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 002154 | GA |
NPI | 1003997131 |
---|---|
Provider Name | Dr. Parveen Jaglan |
First Address | Smyrna, GA 30080-2980 |
Second Address | Smyrna, GA 30080-2980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002154 | LICENSE NUMBER (01) | GA |