Healthcare Provider Details

I. General information

NPI: 1174464317
Provider Name (Legal Business Name): JADE JOY HERRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 LANCASTER DR NE # DE
SALEM OR
97305-1391
US

IV. Provider business mailing address

835 PIEDMONT AVE NW APT 3
SALEM OR
97304-3700
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-5982
  • Fax:
Mailing address:
  • Phone: 503-362-5982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number267546
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: