Provider Demographics
NPI:1124849310
Name:JETHWA, JASMINE FARISHA (OD)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:FARISHA
Last Name:JETHWA
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:646-417-7732
Practice Address - Street 1:1209 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1404
Practice Address - Country:US
Practice Address - Phone:646-757-2290
Practice Address - Fax:646-417-7732
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist