Provider Demographics
NPI:1508387283
Name:RAIS, JEFFREY LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:RAIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:118 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2204
Mailing Address - Country:US
Mailing Address - Phone:586-464-1479
Mailing Address - Fax:586-464-1480
Practice Address - Street 1:13943 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-3203
Practice Address - Country:US
Practice Address - Phone:216-815-1460
Practice Address - Fax:216-803-3444
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHOPT6575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist