Individual
DR. JEFFREY K CUSTRED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2128 JIM REDMAN PKWY, PLANT CITY, FL 33563-7105
(813) 752-3320
(813) 759-6595
Mailing address
5795 LAKE VICTORIA DR, LAKELAND, FL 33813-4709
(863) 646-0219
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC002268
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669411021
MEDICARE NPI
FL
05
—
620022200
—
FL
Enumeration date
06/04/2006
Last updated
06/02/2008
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