Provider Demographics
NPI:1255834768
Name:OUTINEN, JEREMY NORMAN (OD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:NORMAN
Last Name:OUTINEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3349 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5513
Mailing Address - Country:US
Mailing Address - Phone:585-381-1613
Mailing Address - Fax:585-381-0718
Practice Address - Street 1:3349 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5513
Practice Address - Country:US
Practice Address - Phone:585-381-1613
Practice Address - Fax:585-381-0718
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYORT009058152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy