Provider Demographics
NPI:1144937558
Name:DAN L JEFFERIES LLC
Entity type:Organization
Organization Name:DAN L JEFFERIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEFFERIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-490-4735
Mailing Address - Street 1:507 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-3427
Mailing Address - Country:US
Mailing Address - Phone:541-490-4735
Mailing Address - Fax:
Practice Address - Street 1:2190 9TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-4819
Practice Address - Country:US
Practice Address - Phone:239-263-1221
Practice Address - Fax:239-263-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty