MEDICARE: DR. JESSICA MICHAEL TADROS O.D.

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	14816	CA

General Provider Information

NPI Number	:	1295165785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA MICHAEL TADROS O.D.

Provider Business Mailing Address
First Line	:	29826 HAUN RD
Second Line	:	SUITE 100
City	:	MENIFEE
State	:	CA
Zip	:	92586-6546
Country	:	US
Telephone Number	:	951-301-8888
Fax Number	:	951-301-4137

Provider Business Practice Location Address
First Line	:	29826 HAUN RD
Second Line	:	SUITE 100
City	:	MENIFEE
State	:	CA
Zip	:	92586-6546
Country	:	US
Telephone Number	:	951-301-8888
Fax Number	:	951-301-4137

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

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	04/21/2017

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