MEDICARE: JAY CARL JENKINS 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	4901003630	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	410036674	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13147	OTHER	MI	SPECTERA
2	230603	OTHER	MI	NVA
3	900G210200	OTHER	MI	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	13146	OTHER	MI	SPECTERA
6	MI3630	OTHER	MI	EYEMED
7	1178430001	OTHER	MI	DMERC
9	P35872F	OTHER	MI	BLUE CARE NETWORK
10	900022079	OTHER	MI	PRIORITY HEALTH
11	900G210200	OTHER	MI	BLUE CARE NETWORK
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841230711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY CARL JENKINS OD

Provider Business Mailing Address
First Line	:	6525A W HOUGHTON LAKE DR
Second Line	:
City	:	HOUGHTON LAKE
State	:	MI
Zip	:	48629-9789
Country	:	US
Telephone Number	:	989-422-5731
Fax Number	:	989-422-2534

Provider Business Practice Location Address
First Line	:	6525A W HOUGHTON LAKE DR
Second Line	:
City	:	HOUGHTON LAKE
State	:	MI
Zip	:	48629-9789
Country	:	US
Telephone Number	:	989-422-5731
Fax Number	:	989-422-2534

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	06/29/2012

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