MEDICARE: DR. JEFFREY ALAN BROOKS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000897	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235138322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY ALAN BROOKS O.D.

Provider Business Mailing Address
First Line	:	6818 MARKET ST
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2412
Country	:	US
Telephone Number	:	610-734-1556
Fax Number	:	610-352-7481

Provider Business Practice Location Address
First Line	:	6818 MARKET ST
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2412
Country	:	US
Telephone Number	:	610-734-1556
Fax Number	:	610-352-7481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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