Provider Demographics
NPI:1578857934
Name:PONT, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:PONT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 BUSTLETON AVE
Mailing Address - Street 2:DEPUTY EYEWEAR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1651
Mailing Address - Country:US
Mailing Address - Phone:215-673-1267
Mailing Address - Fax:215-676-7085
Practice Address - Street 1:13020 BUSTLETON AVE
Practice Address - Street 2:DEPUTY EYEWEAR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1651
Practice Address - Country:US
Practice Address - Phone:215-673-1267
Practice Address - Fax:215-676-7085
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherBLOCK VISION