Individual
DR. JEREDINE M KALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
14 CONSULTANT PL STE 100, DURHAM, NC 27707-6326
(919) 493-3668
(919) 490-5594
Mailing address
PO BOX 208869, DALLAS, TX 75320-8869
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2812
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA4048B
MEDICARE
NC
Enumeration date
09/19/2022
Last updated
03/20/2025
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