Provider Demographics
NPI:1790920072
Name:FEIST, JODIE
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:FEIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1001
Mailing Address - Country:US
Mailing Address - Phone:516-822-8971
Mailing Address - Fax:516-822-3271
Practice Address - Street 1:436 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1001
Practice Address - Country:US
Practice Address - Phone:516-822-8971
Practice Address - Fax:516-822-3271
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006095156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician