MEDICARE: JENNIFER ANN PATHIYIL 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
1	152W00000X	Optometrist	OPC5424	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124545827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANN PATHIYIL OD

Provider Business Mailing Address
First Line	:	11645 BISCAYNE BLVD STE 207
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3138
Country	:	US
Telephone Number	:	305-538-8835
Fax Number	:	305-994-0054

Provider Business Practice Location Address
First Line	:	11645 BISCAYNE BLVD STE 103
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-3138
Country	:	US
Telephone Number	:	305-538-8835
Fax Number	:	305-994-0054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	11/18/2024

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