Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5403 | CA |
NPI | 1013152263 |
---|---|
Provider Name | Jerome M Hirsch |
First Address | Santa Maria, CA 93454-5159 |
Second Address | Santa Maria, CA 93454-5159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2008 |
Last Update Date | 02/12/2008 |