Provider Demographics
NPI:1548313265
Name:VODAK, JEFFREY L (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:VODAK
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-0100
Mailing Address - Country:US
Mailing Address - Phone:608-588-2612
Mailing Address - Fax:608-588-3227
Practice Address - Street 1:105 EAST JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588
Practice Address - Country:US
Practice Address - Phone:608-588-2612
Practice Address - Fax:608-588-3227
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist