MEDICARE: DR. JENNIFER K BULMANN O.D.

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	2163	TN
2	152W00000X	Optometrist	2011037755	MO
3	152W00000X	Optometrist	046009248	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01342597	OTHER	IL	RAILROAD MEDICARE NUMBER

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2163	OTHER	TN	OD

General Provider Information

NPI Number	:	1811980964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER K BULMANN O.D.

Provider Business Mailing Address
First Line	:	3500 W PETERSON AVE
Second Line	:	STE 401
City	:	CHICAGO
State	:	IL
Zip	:	60659-3306
Country	:	US
Telephone Number	:	773-588-3090
Fax Number	:	773-588-3210

Provider Business Practice Location Address
First Line	:	3500 W PETERSON AVE
Second Line	:	STE 401
City	:	CHICAGO
State	:	IL
Zip	:	60659-3306
Country	:	US
Telephone Number	:	773-588-3090
Fax Number	:	773-588-3210

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. JENNIFER K BULMANN O.D.” Practice Location

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