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NPI Code Detail

MEDICARE: JANE HERMAN OD

MEDICARE:   JANE  HERMAN  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
1152W00000XOptometristIL

General Provider Information

NPI Number : 1073613279
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE HERMAN OD
Provider Business Mailing Address
First Line : 3000 W DEYOUNG ST STE 500
Second Line :
City : MARION
State : IL
Zip : 62959-5551
Country : US
Telephone Number : 618-993-4484
Fax Number : 618-997-3003
Provider Business Practice Location Address
First Line : 3000 W DEYOUNG ST STE 500
Second Line :
City : MARION
State : IL
Zip : 62959-5551
Country : US
Telephone Number : 618-993-4484
Fax Number : 618-997-3003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 07/09/2007

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Directions to “ JANE HERMAN OD” Practice Location

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