=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609130624
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESUS RAMON MERINO O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2012
-----------------------------------------------------
Last Update Date | 03/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14905 PARAMOUNT BLVD STE E
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-3440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 174-996-1136
-----------------------------------------------------
Fax | 714-996-0793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14905 PARAMOUNT BLVD STE E
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-3440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-633-6046
-----------------------------------------------------
Fax | 562-633-0260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 14412
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------