Individual
DR. JEFFREY CLAY FOGT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
101 CLINTON ST, STE 1000, DEFIANCE, OH 43512-2176
(419) 782-4831
(419) 784-0197
Mailing address
101 CLINTON ST, STE 1000, DEFIANCE, OH 43512-2176
(419) 782-4831
(419) 784-0197
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4103
OH
152W00000X
Optometrist
T1490
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0357310001
DMEPOS
OH
Enumeration date
08/25/2005
Last updated
07/08/2007
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