Provider Demographics
NPI:1043403595
Name:RICKS, JEFFREY STEWART (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEWART
Last Name:RICKS
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 1:39931 SAN SIMEON CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3619
Mailing Address - Country:US
Mailing Address - Phone:510-449-7669
Mailing Address - Fax:
Practice Address - Street 1:39931 SAN SIMEON CT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3619
Practice Address - Country:US
Practice Address - Phone:510-449-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2007-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist