Provider Demographics
NPI:1316160252
Name:SCIESZKA, JEFFREY (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:SCIESZKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3338
Mailing Address - Country:US
Mailing Address - Phone:269-429-6781
Mailing Address - Fax:269-429-5006
Practice Address - Street 1:2810 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3338
Practice Address - Country:US
Practice Address - Phone:269-429-6781
Practice Address - Fax:269-429-5006
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003732152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist