Provider Demographics
NPI:1720013394
Name:JEFFERS, AIMEE R (OD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:R
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4129
Mailing Address - Country:US
Mailing Address - Phone:614-488-1754
Mailing Address - Fax:
Practice Address - Street 1:1018 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-6109
Practice Address - Country:US
Practice Address - Phone:937-399-0282
Practice Address - Fax:937-399-1854
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5310152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU94188Medicare UPIN