Individual
DR. JARED ROBERT WIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 STEIN PLZ FL 1, LOS ANGELES, CA 90095-5000
(310) 825-3090
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
(310) 301-8707
(619) 532-7272
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207W00000X
Ophthalmology Physician
Primary
16655
CA
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
16655
CA
Other
Enumeration date
04/27/2017
Last updated
07/14/2023
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