Provider Demographics
NPI:1629059381
Name:STERN, JODI LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LYN
Last Name:STERN
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 1:7352 NW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1266
Mailing Address - Country:US
Mailing Address - Phone:305-418-2025
Mailing Address - Fax:305-418-9882
Practice Address - Street 1:7352 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1266
Practice Address - Country:US
Practice Address - Phone:305-418-2025
Practice Address - Fax:305-418-9882
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002748152W00000X, 152WC0802X, 152WL0500X, 152WS0006X, 152WV0400X, 152WX0102X
FLOPC02748152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
20535ZMedicare ID - Type Unspecified
U52892Medicare UPIN