Provider Demographics
NPI:1518969302
Name:POLAND, JEFFREY ALAN (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:POLAND
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 1:2 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2329
Mailing Address - Country:US
Mailing Address - Phone:301-777-7777
Mailing Address - Fax:301-777-7798
Practice Address - Street 1:2 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2329
Practice Address - Country:US
Practice Address - Phone:301-777-7777
Practice Address - Fax:301-777-7798
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD438848800Medicaid
MDLV23OtherCAREFIRST RENDER 61788101
MDLV23OtherCAREFIRST RENDER 61788101
MD0656270001Medicare NSC
MD452L265CMedicare PIN