Provider Demographics
NPI:1306858030
Name:THERRIEN, JANE MIREILLE (OD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MIREILLE
Last Name:THERRIEN
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 1:4472 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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV08369Medicare UPIN