Edward Renea Jett, OPTICIAN

Primary specialty

OpticianTaxonomy code 156FX1800X

License

007668-1 Issued in NY

Practice address

6265 Brockport Spencerport Rd
Brockport, NY 14420

Phone

(585) 395-0456

Fax

(585) 395-1195

NPI assigned

Dec 19, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513641600000",
    "number": "1255847802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6265 BROCKPORT SPENCERPORT RD",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144202605",
            "telephone_number": "585-395-0456",
            "fax_number": "585-395-1195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6265 BROCKPORT SPENCERPORT RD",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "14420",
            "telephone_number": "585-395-0456",
            "fax_number": "585-395-1195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETT",
        "first_name": "EDWARD",
        "middle_name": "RENEA",
        "name_prefix": "Mr.",
        "credential": "OPTICIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-19",
        "last_updated": "2017-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "007668-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phillip Ilievski
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• Kelsey Eleanor Izzo, MD
• John Leonard Jackson
• Regina Janda, LPN
• Eric Robert Johnson, MD
• Julia Elizabeth Johnson
• Lydia Alice Johnson
• Bambi Jones-Olsen, CDA
• Vanessa Eulinda Junor, D.O.

• Optician in Brockport, NY
• Providers in Brockport, NY by specialty
• Optician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.