Provider Demographics
NPI:1568752822
Name:FERRIS, JEFFREY D (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:FERRIS
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 1:4855 KIETZKE LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6549
Mailing Address - Country:US
Mailing Address - Phone:775-827-4058
Mailing Address - Fax:775-827-5854
Practice Address - Street 1:4855 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6549
Practice Address - Country:US
Practice Address - Phone:775-827-4058
Practice Address - Fax:775-827-5854
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist