Provider Demographics
NPI:1215457437
Name:ASLAM, JENNIFER (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:ASLAM
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 1:302 W GRAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5108
Mailing Address - Country:US
Mailing Address - Phone:310-414-9595
Mailing Address - Fax:310-414-0137
Practice Address - Street 1:302 W GRAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5108
Practice Address - Country:US
Practice Address - Phone:310-414-9595
Practice Address - Fax:310-414-0137
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33752TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist