Provider Demographics
NPI:1013152263
Name:HIRSCH, JEROME M (OD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:M
Last Name:HIRSCH
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 1:363 TOWN CTR E
Mailing Address - Street 2:SANTA MARIA TOWN CTR SPC G-73
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5159
Mailing Address - Country:US
Mailing Address - Phone:805-922-6118
Mailing Address - Fax:
Practice Address - Street 1:363 TOWN CTR E
Practice Address - Street 2:SANTA MARIA TOWN CTR SPC G-73
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5159
Practice Address - Country:US
Practice Address - Phone:805-922-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist