MEDICARE: DR. JOHN HEIDT JETT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1477	GA

General Provider Information

NPI Number	:	1134231830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN HEIDT JETT O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1931
Second Line	:
City	:	TYBEE ISLAND
State	:	GA
Zip	:	31328-1931
Country	:	US
Telephone Number	:	912-507-4896
Fax Number	:	912-352-8027

Provider Business Practice Location Address
First Line	:	1955 E MONTGOMERY XRD
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31406-5036
Country	:	US
Telephone Number	:	912-352-8029
Fax Number	:	912-352-8027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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