Provider Demographics
NPI:1962924951
Name:MORAN, JENNA (OD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24200 E SMOKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1381
Mailing Address - Country:US
Mailing Address - Phone:720-870-2828
Mailing Address - Fax:720-870-2117
Practice Address - Street 1:24200 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1381
Practice Address - Country:US
Practice Address - Phone:720-870-2828
Practice Address - Fax:720-870-2117
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0003309OtherSTATE LICENSE
MS4358277OtherDEA REGISTRATION NUMBER