Provider Demographics
NPI:1285798504
Name:TARANTO, JEFFREY L (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:TARANTO
Suffix:
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 1:1626 MALCOLM AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-7830
Mailing Address - Country:US
Mailing Address - Phone:954-303-1882
Mailing Address - Fax:818-530-7761
Practice Address - Street 1:621 S WESTERN AVE STE 214
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3042
Practice Address - Country:US
Practice Address - Phone:213-389-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007083152W00000X
CA14381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist