Provider Demographics
NPI:1063585990
Name:MANN, MANJEET KAUR (OD)
Entity type:Individual
Prefix:DR
First Name:MANJEET
Middle Name:KAUR
Last Name:MANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MANJEET
Other - Middle Name:KAUR
Other - Last Name:UPPAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2816 VERNON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5776
Mailing Address - Country:US
Mailing Address - Phone:925-325-9141
Mailing Address - Fax:
Practice Address - Street 1:725 UNIVERSITY AVE
Practice Address - Street 2:A
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2129
Practice Address - Country:US
Practice Address - Phone:650-329-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01123Medicare UPIN