Provider Demographics
NPI:1619246295
Name:ANASTASIA JOBSON PA
Entity Type:Organization
Organization Name:ANASTASIA JOBSON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-497-0846
Mailing Address - Street 1:955 NW 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4372
Mailing Address - Country:US
Mailing Address - Phone:954-558-0770
Mailing Address - Fax:954-733-2879
Practice Address - Street 1:3001 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1913
Practice Address - Country:US
Practice Address - Phone:954-497-0846
Practice Address - Fax:954-733-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC3904OtherSTATE LICENSE NUMBER