Provider Demographics
NPI:1306005764
Name:ZADOFF, JAIME BROOKE (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:BROOKE
Last Name:ZADOFF
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:BROOKE
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4646 JOHN R ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1916
Mailing Address - Country:US
Mailing Address - Phone:313-576-1000
Mailing Address - Fax:
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004460152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5330000926OtherBOARD OF PHARMACY CONTROLLED SUBSTANCE LICENSE
MI4901004460OtherBOARD OF OPTOMETRY DIAGNOSTIC/THERAPEUTIC PHARMACEUTICAL AGENTS CERT.