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General NPI Number Information
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NPI Number | 1851467187
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Entity Type | Individual
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Provider Name | JEFFREY DAVID EIDMAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 1 COOPERTOWNE BLVD
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City | SOMERDALE
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State | NJ
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Zip | 08083-1433
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Country | US
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Telephone | 856-545-9057
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Fax | 856-309-1262
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Provider Business Mailing Address
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Address Line | 1 COOPERTOWNE BLVD
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City | SOMERDALE
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State | NJ
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Zip | 08083-1433
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Country | US
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Telephone | 856-545-9057
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Fax | 856-309-1262
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 27OA00276300
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License Number State | NJ
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