Provider Demographics
NPI:1609130624
Name:MERINO, JESUS RAMON (OD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:RAMON
Last Name:MERINO
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 1:14905 PARAMOUNT BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3440
Mailing Address - Country:US
Mailing Address - Phone:562-633-6046
Mailing Address - Fax:562-633-0260
Practice Address - Street 1:14905 PARAMOUNT BLVD STE E
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3440
Practice Address - Country:US
Practice Address - Phone:174-996-1136
Practice Address - Fax:714-996-0793
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14412152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB213849Medicare PIN
CACB213848Medicare PIN