Healthcare Provider Details

I. General information

NPI: 1154654754
Provider Name (Legal Business Name): ERIN CHRISTINE JENEWEIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR SANFORD ZIFF BLDG. 2ND FLOOR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

6960 SW 39TH ST APT. 301
DAVIE FL
33314-2411
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4200
  • Fax: 954-262-1818
Mailing address:
  • Phone: 847-224-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: