Provider Demographics
NPI:1285245274
Name:JAHNER, JOSEPH FOSTER (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FOSTER
Last Name:JAHNER
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 1:1012 E COMPETINE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-1962
Mailing Address - Country:US
Mailing Address - Phone:641-891-7263
Mailing Address - Fax:
Practice Address - Street 1:935 BROAD ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2047
Practice Address - Country:US
Practice Address - Phone:641-891-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty