Healthcare Provider Details

I. General information

NPI: 1538483151
Provider Name (Legal Business Name): JENNIFER J DOTTERWEICH OPTOMETRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 E MAIN ST
AVON NY
14414-1421
US

IV. Provider business mailing address

243 E MAIN ST
AVON NY
14414-1475
US

V. Phone/Fax

Practice location:
  • Phone: 585-226-3400
  • Fax: 585-438-4148
Mailing address:
  • Phone: 508-837-3790
  • Fax: 585-438-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6150
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number6150
License Number StateNY

VIII. Authorized Official

Name: DR. JENNIFER J DOTTERWEICH
Title or Position: PRESIDENT
Credential: OD
Phone: 585-226-3400