Provider Demographics
NPI:1013130756
Name:FRIEDMAN, JEROME DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:DAVID
Last Name:FRIEDMAN
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 1:17019 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1003
Mailing Address - Country:US
Mailing Address - Phone:954-432-5822
Mailing Address - Fax:954-432-5466
Practice Address - Street 1:17019 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1003
Practice Address - Country:US
Practice Address - Phone:954-432-5822
Practice Address - Fax:954-432-5466
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T84038Medicare UPIN
19080Medicare ID - Type Unspecified