Provider Demographics
NPI:1750386843
Name:ANSHEL, JEFFREY (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ANSHEL
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 1:128 W E ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3519
Mailing Address - Country:US
Mailing Address - Phone:760-931-1390
Mailing Address - Fax:
Practice Address - Street 1:128 W E ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3519
Practice Address - Country:US
Practice Address - Phone:760-931-1390
Practice Address - Fax:760-931-9545
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP 5980Medicare ID - Type Unspecified
CAT70077Medicare UPIN