Provider Demographics
NPI:1316255805
Name:ALVAREZ, JENNIFER ANN (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:EPSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16970A W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5952
Mailing Address - Country:US
Mailing Address - Phone:262-797-9322
Mailing Address - Fax:
Practice Address - Street 1:16970A W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5952
Practice Address - Country:US
Practice Address - Phone:262-797-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist