Provider Demographics
NPI:1053818385
Name:JENNIFER DJIE WITKOWSKI, O.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JENNIFER DJIE WITKOWSKI, O.D. A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DJIE
Authorized Official - Last Name:WITKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-540-3787
Mailing Address - Street 1:1760 S PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1760 S PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5902
Practice Address - Country:US
Practice Address - Phone:310-540-3787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306370093OtherSUSAN CHOE
CA1619028453OtherJENNIFER DJIE-WITKOWSKI
CA1255484556OtherCARRIE SAITO