MR. EDWARD RENEA JETT (NPI# 1255847802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255847802 |
| Entity Type | Individual |
| Full Name | MR. EDWARD RENEA JETT |
| Credential | OPTICIAN |
| Practice Address |
6265 Brockport Spencerport Rd Brockport NY 14420 |
| Mailing Address |
6265 Brockport Spencerport Rd Brockport NY 14420-2605 |
| Practice Telephone | 5853950456 |
| Practice Fax Number | 5853951195 |
| Mailing Telephone | 5853950456 |
| Mailing Fax Number | 5853951195 |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2017-12-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
007668-1 | NY | Eye and Vision Services Providers |
| Street Address |
6265 BROCKPORT SPENCERPORT RD |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205853371 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2006-07-16 |
| 1558613349 | Melissa Carvin | Hearing Instrument Specialist | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2012-10-04 |
| 1720334329 | Krystal A Wallis | Pharmacist | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2012-08-01 |
| 1619256435 | Melissa Ann Kaltenbach | Pharmacist | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2011-08-10 |
| 1003131293 | Timothy Conlon | Pharmacist | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2010-03-31 |
| 1841513942 | Carrie Lynn Degeorge | Pharmacist | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2010-03-04 |
| 1083845135 | Sharon Cristine Huynh | Optometrist | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2009-08-06 |
| 1790961324 | Stephen Edward Semo | Pharmacist | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2008-01-14 |
| 1043425531 | Hearing Health LLC | Hearing Aid Equipment | 6265 Brockport Spencerport Rd, Brockport, NY 14420-2605 | 2007-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194217471 | Brianna Lynn Bunch | Licensed Practical Nurse | 126 White Road, Brockport, NY 14420 | 2018-06-03 |
| 1174012785 | Penny Bowers | Massage Therapist | 27 Market Street, Upstairs, Brockport, NY 14420 | 2018-05-09 |
| 1386172062 | Allison Manly | Dentist | 1000 Transit Way, Brockport, NY 14420 | 2017-05-25 |
| 1235518143 | Erin B Chapman | Physical Medicine & Rehabilitation | 350 New Campus Drive, Brockport, NY 14420 | 2015-05-26 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1689946303 | Beverly Whiteman | Registered Nurse | 40 Allen St., Brockport, NY 14420 | 2012-01-27 |
| 1316217425 | Julie Ann Knapp | Registered Nurse | 40 Allen Street, Brockport Central School District, Brockport, NY 14420 | 2012-01-05 |
| 1851678965 | Jennifer Anne Cohen | Registered Nurse | 188 Utica Street, Brockport, NY 14420 | 2011-11-03 |
| 1205088960 | Amy Maureen Hennessy | Obstetrics & Gynecology | 6668 Fourth Section Rd Ste 500, Brockport, NY 14420 | 2008-10-14 |
| 1053454884 | Nancy S Iafrati | Nurse Practitioner | Suny Brockport Student Health Center, 350 New Campus Drive, Brockport, NY 14420 | 2007-02-14 |
| Find all providers in zip 14420 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649319401 | Wal-mart Stores, East, Lp | Technician/Technologist | 6265 Spencerport Rd, Brockport, NY 14420 | 2007-02-06 |
| 1740350370 | Leelee Muesebeck | Technician/Technologist | 100 Main St, Brockport, NY 14420 | 2006-11-09 |
| 1710919923 | Alicia Marie Rich | Technician/Technologist | 300 West Ave, Brockport, NY 14420-1118 | 2006-07-07 |
| 1497787600 | Gina Marie Lippa | Technician/Technologist | 300 West Ave, Brockport, NY 14420-1118 | 2006-07-07 |
| 1235161100 | Jennifer Jeanne Proia-cessna | Technician/Technologist | 300 West Ave, Brockport, NY 14420-1118 | 2006-07-07 |
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|---|---|---|---|---|
| 1982202628 | Smart Vision Care Inc. | Technician/Technologist | 5107 108th St # B, Corona, NY 11368-3304 | 2020-10-14 |
| 1396350757 | Galo Andrade II | Technician/Technologist | 123 State Route 94 S Ste 2, Warwick, NY 10990-3664 | 2020-09-12 |
| 1962016022 | Mathilde Brecy | Technician/Technologist | 248 Columbus Ave, New York, NY 10023-3331 | 2020-09-04 |
| 1417566258 | Neziah Maloney | Technician/Technologist | 43 President St, Huntington Station, NY 11746-2345 | 2020-07-28 |
| 1689290199 | Akeel Adil | Technician/Technologist | 9142 82nd St, Jamaica, NY 11421-2914 | 2020-06-20 |
| 1588289292 | Vision Express Optix Inc | Technician/Technologist | 98106 Queens Blvd, Rego Park, NY 11374-4354 | 2020-06-09 |
| 1942821749 | Frank Panzarella | Technician/Technologist | 364 Vermont St, Lindenhurst, NY 11757-5241 | 2020-05-03 |
| 1649806761 | Courtney Zhang | Technician/Technologist | 10204 Flatlands Avenue, Store 2906, Brooklyn, NY 11236 | 2020-03-20 |
| 1023644291 | Martha Canon | Technician/Technologist | 1440 Broadway # 10826, New York, NY 10018-2301 | 2020-03-19 |
| 1619500964 | Raphael Optical Inc. | Technician/Technologist | 303 Wyckoff Ave, Brooklyn, NY 11237-5805 | 2020-02-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.