Healthcare Provider Details

I. General information

NPI: 1326782947
Provider Name (Legal Business Name): JENA ANN MEYER OD, FAAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9117 LYNDALE AVE S
BLOOMINGTON MN
55420-3522
US

IV. Provider business mailing address

9117 LYNDALE AVE S
BLOOMINGTON MN
55420-3522
US

V. Phone/Fax

Practice location:
  • Phone: 952-592-4424
  • Fax:
Mailing address:
  • Phone: 952-592-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6117
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4046
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number61484115
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: