Provider Demographics
NPI:1013932516
Name:JEFCOAT, HAROLD A (O D)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:A
Last Name:JEFCOAT
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SGT PRENTISS DR STE 6
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4743
Mailing Address - Country:US
Mailing Address - Phone:601-442-4354
Mailing Address - Fax:
Practice Address - Street 1:29 SGT PRENTISS DR STE 6
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4743
Practice Address - Country:US
Practice Address - Phone:601-442-4354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS477152W00000X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST20797Medicare UPIN
MS560945626Medicare ID - Type Unspecified