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NPI Code Detail

MEDICARE: JARED HAGAN OPTOMETRY

MEDICARE: JARED HAGAN OPTOMETRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT14385TLGCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OPT14385TLGOTHERCACALIFORNIA OPTOMETRY LICENSE

General Provider Information

NPI Number : 1396160479
Entity Type Code : Organization
Provider Name (Legal Business Name) : JARED HAGAN OPTOMETRY
Provider Business Mailing Address
First Line : 7007 FRIARS RD STE 667A
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1148
Country : US
Telephone Number : 858-876-7456
Fax Number : 888-723-8436
Provider Business Practice Location Address
First Line : 5929 MILDRED ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-1422
Country : US
Telephone Number : 858-876-7456
Fax Number : 888-723-8436
Authorized Official
Title or Position : OPTOMETRIST
Name : DR. JARED HAGAN
Credential : O.D.
Telephone Number : 858-876-7456
Provider Enumeration Date : 02/25/2014
Last Update Date : 02/25/2014

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Directions to “JARED HAGAN OPTOMETRY ” Practice Location

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