Provider Demographics
NPI:1205967627
Name:MUSKAT, JEROME DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:DAVID
Last Name:MUSKAT
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:7301 N SHADELAND AVE
Practice Address - Street 2:STE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2085
Practice Address - Country:US
Practice Address - Phone:317-842-3937
Practice Address - Fax:317-842-3621
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN18002036A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400072649Medicare PIN