Provider Demographics
NPI:1952430886
Name:RADLIFF, JEROME CLIFFORD III (OD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:CLIFFORD
Last Name:RADLIFF
Suffix:III
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 1:44-010 MALUKAI PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2540
Mailing Address - Country:US
Mailing Address - Phone:262-366-9956
Mailing Address - Fax:
Practice Address - Street 1:11250 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:STE15357
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1088
Practice Address - Country:US
Practice Address - Phone:262-366-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001592152W00000X
HI769152W00000X
FLOPC 004603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist