Provider Demographics
NPI:1386897874
Name:PAVONE, KANWALPREET KAUR (OD)
Entity type:Individual
Prefix:DR
First Name:KANWALPREET
Middle Name:KAUR
Last Name:PAVONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KANWALPREET
Other - Middle Name:KAUR
Other - Last Name:BAGRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 208177
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8177
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:4431 HEMMINGWAY DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2465
Practice Address - Country:US
Practice Address - Phone:734-634-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N34040064Medicare PIN