Provider Demographics
NPI:1124165618
Name:DULL, JENNIFER H (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:H
Last Name:DULL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LAKE ELMO DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3066
Mailing Address - Country:US
Mailing Address - Phone:406-252-9927
Mailing Address - Fax:
Practice Address - Street 1:430 LAKE ELMO DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3066
Practice Address - Country:US
Practice Address - Phone:406-252-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0483412Medicaid
MTP00738886OtherRAILROAD MEDICARE
MT28371OtherBCBS
MT000084260OtherMEDICARE GROUP
011001901OtherMEDICARE PTAN
MT0445350001Medicare NSC
MT000084260OtherMEDICARE GROUP
011001901OtherMEDICARE PTAN