Provider Demographics
NPI:1972536175
Name:MORER, JEFFREY L (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:MORER
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 1:6338 LANTANA RD STE 57
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6652
Mailing Address - Country:US
Mailing Address - Phone:561-969-9995
Mailing Address - Fax:561-892-0920
Practice Address - Street 1:6338 LANTANA RD STE 57
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6652
Practice Address - Country:US
Practice Address - Phone:561-969-9995
Practice Address - Fax:561-892-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3449152W00000X
TX6683T152W00000X
WI2666-035152W00000X
FLOPC2300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38597000Medicaid
TX171459401Medicaid
MAW15838OtherBLUE CROSS BLUE SHIELD
FL086908200Medicaid
MA0393789Medicaid
MA410018563OtherMEDICARE RAILROAD
MAW15838OtherBLUE CROSS BLUE SHIELD
FL20481CMedicare PIN
WI000143050Medicare PIN
MA410018563OtherMEDICARE RAILROAD
TX8F9948Medicare PIN
FL20481BMedicare PIN