Provider Demographics
NPI:1831228428
Name:GYSEL, JEFFREY L (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:GYSEL
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9941 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1923
Mailing Address - Country:US
Mailing Address - Phone:810-227-2050
Mailing Address - Fax:810-220-6555
Practice Address - Street 1:9941 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1923
Practice Address - Country:US
Practice Address - Phone:810-227-2050
Practice Address - Fax:810-220-6555
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4657550001Medicare ID - Type Unspecified