Healthcare Provider Details

I. General information

NPI: 1578562930
Provider Name (Legal Business Name): JACQUES L SURER, JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 5TH AVE SUITE 301
YORK PA
17403-2607
US

IV. Provider business mailing address

1750 5TH AVE SUITE 301
YORK PA
17403-2607
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-7829
  • Fax: 717-854-7718
Mailing address:
  • Phone: 717-843-7829
  • Fax: 717-854-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS002839L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: