Provider Demographics
NPI:1194110403
Name:JACQUELINE E. ZERMENO O.D., P.A.
Entity type:Organization
Organization Name:JACQUELINE E. ZERMENO O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ELIZA
Authorized Official - Last Name:ZERMENO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-412-1983
Mailing Address - Street 1:1621 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2826
Mailing Address - Country:US
Mailing Address - Phone:321-412-1983
Mailing Address - Fax:321-383-0788
Practice Address - Street 1:3550 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-8627
Practice Address - Country:US
Practice Address - Phone:321-268-9239
Practice Address - Fax:321-383-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty