Provider Demographics
NPI:1679988216
Name:JEFFRIES, JENNA (OD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:JEFFRIES
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 1:5274 WOODVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8835
Mailing Address - Country:US
Mailing Address - Phone:330-323-4048
Mailing Address - Fax:
Practice Address - Street 1:3200 ATLANTIC BLVD NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-3933
Practice Address - Country:US
Practice Address - Phone:330-489-9145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6288 T3204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist