Individual
JEFFERY JAY PASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2200 ELMWOOD AVE, STE D-4, LAFAYETTE, IN 47904-2347
(765) 446-2814
(765) 447-2870
Mailing address
2200 ELMWOOD AVE, STE D-4, LAFAYETTE, IN 47904-2347
(765) 446-2814
(765) 447-2870
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002083B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100100720
—
IN
Enumeration date
11/17/2005
Last updated
01/24/2016
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