Provider Demographics
NPI:1053344879
Name:STROH, JENNIFER L (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:STROH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5986
Mailing Address - Country:US
Mailing Address - Phone:860-649-9973
Mailing Address - Fax:
Practice Address - Street 1:178 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5986
Practice Address - Country:US
Practice Address - Phone:860-649-9973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2576641OtherAETNA PROVIDER ID
CT004186567Medicaid
CT004216314Medicaid
CT410045541OtherRAILROAD MEDICARE PROV ID
CTOV9840OtherHEALTHNET PROVIDER ID
CTP2515982OtherOXFORD PROVIDER ID
CT090002357CT03OtherANTHEM PROVIDER ID
CT678214OtherCONNECTICARE PROVIDER ID