Provider Demographics
NPI:1013025683
Name:IRVIN, JEFFREY D (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:IRVIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 566
Mailing Address - Street 2:
Mailing Address - City:HAUBSTADT
Mailing Address - State:IN
Mailing Address - Zip Code:47639-9501
Mailing Address - Country:US
Mailing Address - Phone:812-768-6523
Mailing Address - Fax:
Practice Address - Street 1:634 CROSS VALLEY CIR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5238
Practice Address - Country:US
Practice Address - Phone:812-401-7777
Practice Address - Fax:812-429-0392
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00928487OtherRAILROAD MEDICARE
IN4484690001OtherDMEPOS
IN200394550Medicaid
IN192880AMedicare ID - Type Unspecified
IN200394550Medicaid