Provider Demographics
NPI:1851467187
Name:EIDMAN, JEFFREY DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:EIDMAN
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 1:1 COOPERTOWNE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1433
Mailing Address - Country:US
Mailing Address - Phone:856-545-9057
Mailing Address - Fax:856-309-1262
Practice Address - Street 1:1 COOPERTOWNE BLVD
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1433
Practice Address - Country:US
Practice Address - Phone:856-545-9057
Practice Address - Fax:856-309-1262
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00276300152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management