Individual
MR. EDWARD RENEA JETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
6265 BROCKPORT SPENCERPORT RD, BROCKPORT, NY 14420
(585) 395-0456
(585) 395-1195
Mailing address
6265 BROCKPORT SPENCERPORT RD, BROCKPORT, NY 14420-2605
(585) 395-0456
(585) 395-1195
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
007668-1
NY
Other
Enumeration date
12/19/2017
Last updated
12/19/2017
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