Provider Demographics
NPI:1659377554
Name:WARD, JEFFREY M (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:WARD
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:4445 LAKE FOREST DR
Mailing Address - Street 2:STE 600
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3744
Mailing Address - Country:US
Mailing Address - Phone:514-569-3741
Mailing Address - Fax:937-492-1132
Practice Address - Street 1:1118 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8913
Practice Address - Country:US
Practice Address - Phone:937-492-3755
Practice Address - Fax:937-492-1132
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH4390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0921935Medicaid
OH0921935Medicaid
OH0730208Medicare PIN