Provider Demographics
NPI:1699840025
Name:COLLINS, JEFFREY PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:COLLINS
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:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:ID
Mailing Address - Zip Code:83239-0054
Mailing Address - Country:US
Mailing Address - Phone:208-847-0204
Mailing Address - Fax:208-847-0204
Practice Address - Street 1:184 W 1ST ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:ID
Practice Address - Zip Code:83239
Practice Address - Country:US
Practice Address - Phone:208-847-0204
Practice Address - Fax:208-847-0204
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist