Provider Demographics
NPI:1386831097
Name:KAILA, GURJEET RITA (OD)
Entity type:Individual
Prefix:DR
First Name:GURJEET
Middle Name:RITA
Last Name:KAILA
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 1:511 E KERN AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4210
Mailing Address - Country:US
Mailing Address - Phone:559-688-0661
Mailing Address - Fax:559-688-9210
Practice Address - Street 1:511 E KERN AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4210
Practice Address - Country:US
Practice Address - Phone:559-688-0661
Practice Address - Fax:559-688-9210
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MK1660427OtherDEA NUMBER
CADD509ZMedicare PIN