Provider Demographics
NPI:1902880214
Name:STROSSNER, JEFFREY JAMES (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JAMES
Last Name:STROSSNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5424
Mailing Address - Country:US
Mailing Address - Phone:501-327-4444
Mailing Address - Fax:501-327-3962
Practice Address - Street 1:924 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5424
Practice Address - Country:US
Practice Address - Phone:501-327-4444
Practice Address - Fax:501-327-3962
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125747722Medicaid
AR48805Medicare PIN
ARU50858Medicare UPIN