Jeffrey Glenn Jeruss, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT001332 Issued in GA

Practice address

2255 Sewell Mill Rd
Suite 310
Marietta, GA 30062-2804

Phone

(770) 578-1900

Fax

(770) 578-6623

NPI assigned

Oct 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bolt Eye Group-East Cobb LLC

  • Optometrist
  • Marietta, GA
  • NPI 1548996754
  NPD

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227225600000",
    "number": "1508055732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 SEWELL MILL RD",
            "address_2": "SUITE 310",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622804",
            "telephone_number": "770-578-1900",
            "fax_number": "770-578-6623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 SEWELL MILL RD",
            "address_2": "SUITE 310",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622804",
            "telephone_number": "770-578-1900",
            "fax_number": "770-578-6623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERUSS",
        "first_name": "JEFFREY",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-24",
        "last_updated": "2008-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001332",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "GA",
            "license": "OPT001332",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "GA",
            "license": "OPT001332",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wenqiu Jennings, FNP
• Diane Clary Jensen, MD
• Melanie Jerez-Sherrill
• Jerry E Nutt DDS, PC
• Jerry I. Hochman, Chirorpactor PC
• Michelle Theresa Jesse, PH.D.
• Lorena Jesus, DC
• Leslie A. Jeter, CRNA
• Nancy T Jeter, CRNA
• Krunal Jethwa, M.D

• Optometrist in Marietta, GA
• Providers in Marietta, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.