Provider Demographics
NPI:1730316514
Name:JEEVANPRE K. JOWHAL, O.D., P.A.
Entity type:Organization
Organization Name:JEEVANPRE K. JOWHAL, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEEVANPRE
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOWHAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-467-4039
Mailing Address - Street 1:19655 E COUNTRY CLUB DR
Mailing Address - Street 2:#504
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4803
Mailing Address - Country:US
Mailing Address - Phone:305-467-4039
Mailing Address - Fax:
Practice Address - Street 1:19129 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2310
Practice Address - Country:US
Practice Address - Phone:305-792-4303
Practice Address - Fax:305-792-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3479152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty