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Individual
JARED MARK VINCENT
Active
Individual
JARED MARK VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
025302
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578967
—
LA
01
—
1619189362
GROUP NPI
LA
01
—
1639167836
PROVIDER INDIVIDUAL NPI
LA
01
—
208916544
FEDERAL TAX IDENTIFICATION NUMBER
LA
01
—
5CY25
MEDICARE GROUP
LA
Enumeration date
10/11/2005
Last updated
01/26/2012
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