Provider Demographics
NPI:1770626582
Name:KASHOU, JACLYN (OD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:KASHOU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2713
Mailing Address - Country:US
Mailing Address - Phone:734-728-5400
Mailing Address - Fax:734-728-0017
Practice Address - Street 1:6565 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2713
Practice Address - Country:US
Practice Address - Phone:734-728-5400
Practice Address - Fax:734-728-0017
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist