Active NPI
Jeff Jolley, OD
- Optometrist
- Cambridge, MD
National Provider Identifier
1366533085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TA1056
- Practice address
- 830 Chesapeake Dr
Cambridge, MD 21613-9408 - Phone
- (410) 228-6305
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA1056 | MD | Primary |
Addresses
Primary practice location
830 Chesapeake Dr
Cambridge, MD 21613-9408
Mailing address
56 Moonraker Rd
Berlin, MD 21811-1607
Phone (410) 603-5543
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA1056 | MD | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Salisbury Optical | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366533085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56 MOONRAKER RD",
"city": "BERLIN",
"state": "MD",
"postal_code": "218111607",
"telephone_number": "410-603-5543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 CHESAPEAKE DR",
"city": "CAMBRIDGE",
"state": "MD",
"postal_code": "216139408",
"telephone_number": "410-228-6305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOLLEY",
"first_name": "JEFF",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "TA1056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.