MEDICARE: JENNIFER ALVERSON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	S879TA440	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316959679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ALVERSON OD

Provider Business Mailing Address
First Line	:	15933 CLAYTON RD STE 201
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-2172
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	1800 AL-77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-0169
Country	:	US
Telephone Number	:	256-442-6200
Fax Number	:	256-442-6292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/08/2016

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Directions to “ JENNIFER ALVERSON OD” Practice Location

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