Provider Demographics
NPI:1972703148
Name:ALTHOFF, JAMIE LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:ALTHOFF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:VANDERLOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10903 NW 83RD ST
Mailing Address - Street 2:208
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1726
Mailing Address - Country:US
Mailing Address - Phone:231-598-2103
Mailing Address - Fax:
Practice Address - Street 1:10903 NW 83RD ST
Practice Address - Street 2:208
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1726
Practice Address - Country:US
Practice Address - Phone:231-598-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist