Healthcare Provider Details

I. General information

NPI: 1790611358
Provider Name (Legal Business Name): JENNA HORNER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 E 3RD ST
BLOOMINGTON IN
47405-3603
US

IV. Provider business mailing address

744 E 3RD ST
BLOOMINGTON IN
47405-3603
US

V. Phone/Fax

Practice location:
  • Phone: 812-855-8436
  • Fax:
Mailing address:
  • Phone: 812-855-8436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004687A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: