Healthcare Provider Details

I. General information

NPI: 1609130624
Provider Name (Legal Business Name): JESUS RAMON MERINO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14905 PARAMOUNT BLVD STE E
PARAMOUNT CA
90723-3440
US

IV. Provider business mailing address

14905 PARAMOUNT BLVD STE E
PARAMOUNT CA
90723-3440
US

V. Phone/Fax

Practice location:
  • Phone: 174-996-1136
  • Fax: 714-996-0793
Mailing address:
  • Phone: 562-633-6046
  • Fax: 562-633-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: