Provider Demographics
NPI:1407832124
Name:NASSER, JEFFREY J (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:NASSER
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:PO BOX 128
Mailing Address - Street 2:26289 W US 12
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-0128
Mailing Address - Country:US
Mailing Address - Phone:269-651-7874
Mailing Address - Fax:269-651-4154
Practice Address - Street 1:26289 W US 12
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091
Practice Address - Country:US
Practice Address - Phone:269-651-7874
Practice Address - Fax:269-651-4154
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4585077Medicaid
MI4585077Medicaid
MIN86090001Medicare ID - Type Unspecified