Provider Demographics
NPI:1487655643
Name:BYLAND, JEFFREY B (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:BYLAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S DIVISION AVE
Mailing Address - Street 2:PO BOX E
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1602
Mailing Address - Country:US
Mailing Address - Phone:231-924-4110
Mailing Address - Fax:231-924-5007
Practice Address - Street 1:103 S DIVISION AVE
Practice Address - Street 2:PO BOX E
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1602
Practice Address - Country:US
Practice Address - Phone:231-924-4110
Practice Address - Fax:231-924-5007
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2892598Medicaid
MI410014405OtherMEDICARE RAILROAD
MI900F26506OtherBC BS OF MI
MI410014405OtherMEDICARE RAILROAD
MI2892598Medicaid
MI0F26506Medicare ID - Type Unspecified
MI900F26506OtherBC BS OF MI