Provider Demographics
NPI:1134231830
Name:JETT, JOHN HEIDT (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HEIDT
Last Name:JETT
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:PO BOX 1931
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-1931
Mailing Address - Country:US
Mailing Address - Phone:912-507-4896
Mailing Address - Fax:912-352-8027
Practice Address - Street 1:1955 E MONTGOMERY XRD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5036
Practice Address - Country:US
Practice Address - Phone:912-352-8029
Practice Address - Fax:912-352-8027
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist