=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093130700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY L. MORER, OD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2014
-----------------------------------------------------
Last Update Date | 01/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 ALEXANDER BELL DR SUITE 200
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-964-6681
-----------------------------------------------------
Fax | 888-662-0859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 CROSSING BLVD SUITE 300
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01702-5555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-964-6681
-----------------------------------------------------
Fax | 339-686-2561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | JEFFREY MORER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 561-350-4169
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------