Basic Information
| Provider Information | |||||||||
| NPI: | 1780209304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHANGU | ||||||||
| FirstName: | JASMEEN | ||||||||
| MiddleName: | KAUR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 E CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932916331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597374700 | ||||||||
| FaxNumber: | 5597341247 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 W 5TH ST | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932305029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779603426 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2020 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OD61073340 | WA | N | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152WC0802X | 34668 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.