Provider Demographics
NPI:1689721789
Name:JOBES, JUDY KEIKO (OD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:KEIKO
Last Name:JOBES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:KEIKO
Other - Last Name:INOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:28504 SEAMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4752
Mailing Address - Country:US
Mailing Address - Phone:310-541-2289
Mailing Address - Fax:
Practice Address - Street 1:28504 SEAMOUNT DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-4752
Practice Address - Country:US
Practice Address - Phone:310-541-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9504 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051519Medicare UPIN