Custred, Jeffrey K
Custred, Jeffrey K is an sole proprietor health care provider with primary practice located at 2128 Jim Redman Pkwy , Plant City FL 33563-7105. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Custred, Jeffrey K can be contacted via phone (813) 752-3320.Contact Information
Primary practice address
2128 Jim Redman Pkwy
Plant City FL 33563-7105
Phone: (813) 752-3320
Fax: (813) 759-6595
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPC002268 | Florida |
Profile Details
| NPI number | 1669411021 |
|---|---|
| LBN Legal business name | Custred, Jeffrey K |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 4th, 2006 |
| Last updated | Jun 2nd, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669411021 | NPPES |
| Florida | MEDICAID | 620022200 | |
| Florida | Other | 1669411021 |
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