Provider Demographics
NPI:1316955461
Name:ERRAMOUSPE, JEAN CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CHARLES
Last Name:ERRAMOUSPE
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:PO BOX 19164
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-825-1707
Mailing Address - Fax:775-825-1984
Practice Address - Street 1:5164 MEADOWOOD MALL CIR. F-109
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-825-1707
Practice Address - Fax:775-825-1984
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510002Medicaid
NV100510002Medicaid