Healthcare Provider Details

I. General information

NPI: 1285628123
Provider Name (Legal Business Name): JUDY M JEFFERS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 DENISON PKWY E
CORNING NY
14830-2813
US

IV. Provider business mailing address

207 MADISON AVE
ELMIRA NY
14901-3204
US

V. Phone/Fax

Practice location:
  • Phone: 607-937-5800
  • Fax: 607-398-3341
Mailing address:
  • Phone: 607-734-2984
  • Fax: 607-398-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTU005001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: