Provider Demographics
NPI:1245200617
Name:DOOT, JEFFREY MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARTIN
Last Name:DOOT
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 1:149 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4521
Mailing Address - Country:US
Mailing Address - Phone:860-749-0757
Mailing Address - Fax:860-763-4335
Practice Address - Street 1:149 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4521
Practice Address - Country:US
Practice Address - Phone:860-749-0757
Practice Address - Fax:860-763-4335
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0331190001Medicare NSC
CTU96512Medicare UPIN