MEDICARE: DR. JEFFREY LAWRENCE RAIS 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	OPT6575	OH

General Provider Information

NPI Number	:	1508387283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LAWRENCE RAIS OD

Provider Business Mailing Address
First Line	:	118 CASS AVE
Second Line	:
City	:	MOUNT CLEMENS
State	:	MI
Zip	:	48043-2204
Country	:	US
Telephone Number	:	586-464-1479
Fax Number	:	586-464-1480

Provider Business Practice Location Address
First Line	:	13943 CEDAR RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44118-3203
Country	:	US
Telephone Number	:	216-815-1460
Fax Number	:	216-803-3444

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

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	04/18/2018

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