Provider Demographics
NPI:1073525705
Name:JANE M THERRIEN O.D. , P.A
Entity Type:Organization
Organization Name:JANE M THERRIEN O.D. , P.A
Other - Org Name:WESTON FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:MIREILLE
Authorized Official - Last Name:THERRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-888-9393
Mailing Address - Street 1:4472 WESTON RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3194
Mailing Address - Country:US
Mailing Address - Phone:954-888-9393
Mailing Address - Fax:954-888-9394
Practice Address - Street 1:4472 WESTON RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-3194
Practice Address - Country:US
Practice Address - Phone:954-888-9393
Practice Address - Fax:954-888-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV08369Medicare UPIN