Provider Demographics
NPI:1689674616
Name:TURCOTT, JENNIFER JACOBSON (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JACOBSON
Last Name:TURCOTT
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54829-0250
Mailing Address - Country:US
Mailing Address - Phone:715-822-2091
Mailing Address - Fax:715-822-3624
Practice Address - Street 1:1357 2ND AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:WI
Practice Address - Zip Code:54829-7211
Practice Address - Country:US
Practice Address - Phone:715-822-2091
Practice Address - Fax:715-822-3624
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI-2594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38593200Medicaid
WI410028306OtherRR-PTAN 410028306
WI410040876OtherRR-PTAN 410040876
WI0321190001Medicare NSC
WI0321190002Medicare NSC
WI410028306OtherRR-PTAN 410028306
WI000247425Medicare PIN
U53713Medicare UPIN