Basic Information
Provider Information
NPI: 1467464032
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWITCH
FirstName: JEROME
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8950 TELEGRAPH RD
Address2:  
City: TAYLOR
State: MI
PostalCode: 481808399
CountryCode: US
TelephoneNumber: 3132953937
FaxNumber: 3132952006
Practice Location
Address1: 8950 TELEGRAPH RD
Address2:  
City: TAYLOR
State: MI
PostalCode: 481808399
CountryCode: US
TelephoneNumber: 3132953937
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/12/2006
LastUpdateDate: 06/30/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X5101009244MIY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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