Provider Demographics
NPI:1295862381
Name:OVERBEY, JEFFREY THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:OVERBEY
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 1:4202 MESA ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6314
Mailing Address - Country:US
Mailing Address - Phone:310-490-6575
Mailing Address - Fax:310-327-0545
Practice Address - Street 1:100 SO. BAY PAVILION MALL
Practice Address - Street 2:20700 S. AVALON BLVD. #100
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746
Practice Address - Country:US
Practice Address - Phone:310-327-0545
Practice Address - Fax:310-327-0545
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7028T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070280Medicaid