Healthcare Provider Details

I. General information

NPI: 1386084408
Provider Name (Legal Business Name): MEREDITH JEFFREY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22395 EUREKA RD
TAYLOR MI
48180-6016
US

IV. Provider business mailing address

735 JOHN R RD STE 150
TROY MI
48083-5859
US

V. Phone/Fax

Practice location:
  • Phone: 734-324-0996
  • Fax:
Mailing address:
  • Phone: 248-588-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: