Individual
DR. JACK DEVORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
VUT003734
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000495454001
BS NENY
NY
05
—
01419103
—
NY
01
—
10034805
CDPHP
NY
01
—
410044002
RAILRAOD MEDICARE
NY
01
—
59336
MVP
NY
01
—
C6476
EMPIRE BC
NY
Enumeration date
01/19/2006
Last updated
02/27/2008
Update your record
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