Provider Demographics
NPI:1457473738
Name:JEFFERIES, DAN L (OD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:L
Last Name:JEFFERIES
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 1:2190 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-4819
Mailing Address - Country:US
Mailing Address - Phone:239-263-1221
Mailing Address - Fax:239-431-7075
Practice Address - Street 1:2190 9TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-4819
Practice Address - Country:US
Practice Address - Phone:239-263-1221
Practice Address - Fax:239-431-7075
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1587152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01445147OtherRAIL ROAD MEDICARE
FL19654OtherBCBS OF FLORIDA
FL078756600Medicaid
T93917Medicare UPIN
FL078756600Medicaid