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General NPI Number Information
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NPI Number | 1134231830
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Entity Type | Individual
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Provider Name | JOHN HEIDT JETT O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1955 E MONTGOMERY XRD
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City | SAVANNAH
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State | GA
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Zip | 31406-5036
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Country | US
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Telephone | 912-352-8029
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Fax | 912-352-8027
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Provider Business Mailing Address
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Address Line | PO BOX 1931
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City | TYBEE ISLAND
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State | GA
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Zip | 31328-1931
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Country | US
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Telephone | 912-507-4896
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Fax | 912-352-8027
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1477
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License Number State | GA
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