MEDICARE: DR. JEROME SPLAN 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	4464T	CA

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	:	1366416281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME SPLAN O.D.

Provider Business Mailing Address
First Line	:	16970 SAN FERNANDO MISSION BLVD
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4259
Country	:	US
Telephone Number	:	818-360-7522
Fax Number	:	818-363-8859

Provider Business Practice Location Address
First Line	:	16970 SAN FERNANDO MISSION BLVD
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4259
Country	:	US
Telephone Number	:	818-360-7522
Fax Number	:	818-363-8859

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/06/2023

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