Provider Demographics
NPI:1023075900
Name:AHAUS, JEFFREY JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JAMES
Last Name:AHAUS
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 1:694 W EADS PKWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1171
Mailing Address - Country:US
Mailing Address - Phone:812-537-4733
Mailing Address - Fax:812-537-3934
Practice Address - Street 1:694 W EADS PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1171
Practice Address - Country:US
Practice Address - Phone:812-537-4733
Practice Address - Fax:812-537-3934
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH351887897-00OtherWORKERS COMP
000000031274OtherANTHEM
5752647OtherAETNA
2201319OtherUNITEDHEALTHCARE
172140AMedicare ID - Type Unspecified
5752647OtherAETNA