Provider Demographics
NPI:1255526232
Name:SUTTON, JEFFREY RICHARD (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RICHARD
Last Name:SUTTON
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 1:717 GREENWAY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4991
Mailing Address - Country:US
Mailing Address - Phone:828-265-2020
Mailing Address - Fax:828-264-2257
Practice Address - Street 1:717 GREENWAY RD
Practice Address - Street 2:SUITE C
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4991
Practice Address - Country:US
Practice Address - Phone:828-265-2020
Practice Address - Fax:828-264-2257
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09826OtherBCBSNC
NC1780805804OtherGROUP NPI #
NC8909826Medicaid
NC1780805804OtherGROUP NPI #
NC8909826Medicaid