Provider Demographics
NPI:1912143587
Name:BOGUCKI, JENNIFER MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:BOGUCKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GATEWAY CIR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8650
Mailing Address - Country:US
Mailing Address - Phone:614-274-2020
Mailing Address - Fax:614-272-8059
Practice Address - Street 1:1600 GATEWAY CIR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8650
Practice Address - Country:US
Practice Address - Phone:614-274-2020
Practice Address - Fax:614-272-8059
Is Sole Proprietor?:No
Enumeration Date:2009-01-01
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.122338207W00000X, 207WX0120X
MO2012009706207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist