Individual
DR. JAZMIN A LOGENDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
100 E LEHIGH AVE, SUITE 201, PHILADELPHIA, PA 19125-1012
(215) 634-6563
Mailing address
100 E LEHIGH AVE, SUITE 201, PHILADELPHIA, PA 19125-1012
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG003113
PA
152WL0500X
Low Vision Rehabilitation Optometrist
OEG003113
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00871448
RAIL ROAD MEDICARE
TX
Enumeration date
07/12/2007
Last updated
02/12/2016
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