MEDICARE: DR. JEFFREY ALAN ADLER OD

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	NY3218	NY

General Provider Information

NPI Number	:	1467489633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY ALAN ADLER OD

Provider Business Mailing Address
First Line	:	77 W HENRIETTA AVE
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572
Country	:	US
Telephone Number	:	516-766-0760
Fax Number	:	718-205-5273

Provider Business Practice Location Address
First Line	:	75-37 31ST AVE
Second Line	:	85-21 126TH ST
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11370
Country	:	US
Telephone Number	:	718-205-5797
Fax Number	:	718-205-5273

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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