MEDICARE: DR. JEFFREY C BLUM 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	TUV004648	NY

General Provider Information

NPI Number	:	1588741052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY C BLUM O.D.

Provider Business Mailing Address
First Line	:	56 REYNOLDS DR
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-4928
Country	:	US
Telephone Number	:	516-889-0337
Fax Number	:	516-889-0337

Provider Business Practice Location Address
First Line	:	56 REYNOLDS DR
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-4928
Country	:	US
Telephone Number	:	516-361-3364
Fax Number	:	516-889-0337

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/17/2012

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