Provider Demographics
NPI:1700878006
Name:CALHOUN, JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:CALHOUN
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 1:5488 SHERIDAN DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3888
Mailing Address - Country:US
Mailing Address - Phone:716-631-9970
Mailing Address - Fax:716-631-8809
Practice Address - Street 1:5488 SHERIDAN DR STE 300
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3888
Practice Address - Country:US
Practice Address - Phone:716-631-9970
Practice Address - Fax:716-631-8809
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYORT006035-01152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02534334Medicaid
NYIA0454Medicare ID - Type Unspecified
NY02534334Medicaid