Provider Demographics
NPI:1073035143
Name:NIIDA, JAYMIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAYMIE
Middle Name:
Last Name:NIIDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 HIGHGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5516
Mailing Address - Country:US
Mailing Address - Phone:310-489-5956
Mailing Address - Fax:
Practice Address - Street 1:21540 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5707
Practice Address - Country:US
Practice Address - Phone:310-370-0016
Practice Address - Fax:310-370-1850
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33699TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist