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NPI Code Detail

MEDICARE: JASMINE SERNA OD

MEDICARE: JASMINE SERNA OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152WV0400XVision Therapy Optometrist10080TX
2152W00000XOptometrist10080TX

General Provider Information

NPI Number : 1053921890
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE SERNA OD
Provider Business Mailing Address
First Line : 5836 BIRCHBROOK DR APT 237
Second Line :
City : DALLAS
State : TX
Zip : 75206-4581
Country : US
Telephone Number : 505-414-3988
Fax Number :
Provider Business Practice Location Address
First Line : 5044 TENNYSON PKWY STE B
Second Line :
City : PLANO
State : TX
Zip : 75024-2953
Country : US
Telephone Number : 972-378-4104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2020
Last Update Date : 08/06/2020

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