=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205029147
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOCELYN MARIE HERMAN O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2007
-----------------------------------------------------
Last Update Date | 02/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BHC, M BLDG. 669
-----------------------------------------------------
City | PARRIS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-228-2867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2005 KNIGHT LANE BLDG. H ATTN: MEDICAL STAFF SERVICES NAVY MEDICINE SUPPORT COMMAND
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32212-0140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-542-7200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7071T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------