Provider Demographics
NPI:1366435646
Name:MIGDOL, JEFFREY SETH (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SETH
Last Name:MIGDOL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:246 FEDERAL RD
Mailing Address - Street 2:C 12
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2647
Mailing Address - Country:US
Mailing Address - Phone:203-775-1209
Mailing Address - Fax:203-740-8151
Practice Address - Street 1:246 FEDERAL RD
Practice Address - Street 2:C 12
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2647
Practice Address - Country:US
Practice Address - Phone:203-775-1209
Practice Address - Fax:203-740-8151
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CTG00713152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4087640001OtherNSC
4087640001OtherNSC
T23012Medicare UPIN