Provider Demographics
NPI:1528022068
Name:NESTOR, JEFFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:NESTOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:28900 JOY RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4031
Mailing Address - Country:US
Mailing Address - Phone:734-425-2514
Mailing Address - Fax:734-425-8211
Practice Address - Street 1:28900 JOY RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4031
Practice Address - Country:US
Practice Address - Phone:734-425-2514
Practice Address - Fax:734-425-8211
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008206207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0369780001Medicare NSC