Provider Demographics
NPI:1205827771
Name:SERINO, JAMES PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PHILIP
Last Name:SERINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 W PRIMILIA LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9395
Mailing Address - Country:US
Mailing Address - Phone:517-783-3916
Mailing Address - Fax:
Practice Address - Street 1:350 N WISNER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4225
Practice Address - Country:US
Practice Address - Phone:517-783-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000004902OtherPHP OF SOUTH MICHIGAN
MI5892950001OtherDMERC
MI410020815OtherPALMETTO GBA RR MEDICARE
MIVCM-0142OtherM-CARE
MI900C811800OtherBCBS OF MICHIGAN
MI5448465OtherAETNA
MI5448465OtherAETNA
MI900C811800OtherBCBS OF MICHIGAN