Healthcare Provider Details

I. General information

NPI: 1851752927
Provider Name (Legal Business Name): JEROME D. FRIEDMAN, O.D. L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17019 PINES BLVD
PEMBROKE PINES FL
33027-1003
US

IV. Provider business mailing address

17019 PINES BLVD
PEMBROKE PINES FL
33027-1003
US

V. Phone/Fax

Practice location:
  • Phone: 954-432-5822
  • Fax:
Mailing address:
  • Phone: 954-432-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEROME D. FRIEDMAN
Title or Position: SOLE PROPRIETOR
Credential: O.D.
Phone: 954-432-5822