Provider Demographics
NPI:1306930763
Name:FLORENZ, JILL BARON (OD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:BARON
Last Name:FLORENZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 BAY DALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-757-1350
Mailing Address - Fax:
Practice Address - Street 1:1294 BAY DALE DRIVE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012
Practice Address - Country:US
Practice Address - Phone:410-757-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO 935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU24574Medicare UPIN
MD485LMedicare ID - Type Unspecified