Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 009058 | NY |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 009058 | NY |
N | 152WP0200X | Pediatric Optomitrist | 009058 | NY |
N | 152WS0006X | Sports Vision | 009058 | NY |
N | 152WV0400X | Optomitrist - Vision Therapist | 009058 | NY |
NPI | 1255834768 |
---|---|
Provider Name | Dr. Jeremy Norman Outinen |
First Address | Rochester, NY 14618-1311 |
Second Address | Rochester, NY 14623-3139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2018 |
Last Update Date | 01/10/2019 |