Provider Demographics
NPI:1508919192
Name:HIXENBAUGH, JEFFREY D (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:HIXENBAUGH
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 1:3101 PGA BLVD.
Mailing Address - Street 2:SUITE A101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-627-8185
Mailing Address - Fax:561-627-6456
Practice Address - Street 1:3101 PGA BLVD.
Practice Address - Street 2:SUITE A101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-627-8185
Practice Address - Fax:561-627-6456
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU39381Medicare UPIN
FL20403Medicare ID - Type Unspecified