Provider Demographics
NPI:1801815121
Name:CLELAND, JEFFERY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:MICHAEL
Last Name:CLELAND
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 1:464 W GREY HODGES RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-7502
Mailing Address - Country:US
Mailing Address - Phone:334-702-7881
Mailing Address - Fax:
Practice Address - Street 1:464 W GREY HODGES RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-7502
Practice Address - Country:US
Practice Address - Phone:334-702-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003070152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist