Provider Demographics
NPI:1710033881
Name:STEINER, JERRY
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:STEINER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:STEINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPHTHALMIC DISPENSER
Mailing Address - Street 1:20 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2802
Mailing Address - Country:US
Mailing Address - Phone:631-727-4411
Mailing Address - Fax:631-727-4411
Practice Address - Street 1:20 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2802
Practice Address - Country:US
Practice Address - Phone:631-727-4411
Practice Address - Fax:631-727-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004002-1156FC0801X, 156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Not Answered156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0129490001Medicare ID - Type Unspecified