Provider Demographics
NPI:1396764262
Name:BYERS, JEFFREY L (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:BYERS
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 1:222 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-1531
Mailing Address - Country:US
Mailing Address - Phone:715-258-2020
Mailing Address - Fax:715-258-9301
Practice Address - Street 1:222 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1531
Practice Address - Country:US
Practice Address - Phone:715-258-2020
Practice Address - Fax:715-258-9301
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38586300Medicaid
WIU37086Medicare UPIN
WI0541670001Medicare NSC
WI410022867Medicare PIN
WI000190166Medicare PIN