Provider Demographics
NPI:1306244926
Name:ANNON, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13461 MILNOR RD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9553
Mailing Address - Country:US
Mailing Address - Phone:614-620-0334
Mailing Address - Fax:
Practice Address - Street 1:1635 RIVER VALLEY CIR S
Practice Address - Street 2:RIVER VALLEY MALL
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1465
Practice Address - Country:US
Practice Address - Phone:740-654-9734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist