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General NPI Number Information
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NPI Number | 1437841210
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Entity Type | Organization
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Legal Business Name | JERIN JOSEPH OD, PA
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 13159 CITY CENTER BLVD SPACE L-104
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City | JACKSONVILLE
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State | FL
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Zip | 32218
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Country | US
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Telephone | 904-750-4469
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Fax |
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Provider Business Mailing Address
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Address Line | 7643 GATE PKWY STE 104-2
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3092
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERIN JOSEPH
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Credential | OD
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Telephone | 954-309-8647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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