Provider Demographics
NPI:1730300377
Name:JAMES P. SERINO, O.D. P.C.
Entity type:Organization
Organization Name:JAMES P. SERINO, O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:SERINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-783-6928
Mailing Address - Street 1:306 W WASHINGTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2169
Mailing Address - Country:US
Mailing Address - Phone:517-783-6928
Mailing Address - Fax:517-784-9633
Practice Address - Street 1:306 W WASHINGTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2169
Practice Address - Country:US
Practice Address - Phone:517-783-6928
Practice Address - Fax:517-784-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5448465OtherAETNA
MI410020815OtherPALMETTO GBA RR MEDICARE
MI200000004902OtherPHP OF SOUTH MICHIGAN
MI900C812040OtherBCBS OF MI
MIT32941Medicare UPIN
MI200000004902OtherPHP OF SOUTH MICHIGAN
MI0P43580Medicare PIN