Healthcare Provider Details

I. General information

NPI: 1851396170
Provider Name (Legal Business Name): JENNIFER DEMOTT-CAMP OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W CHESTNUT ST
WASHINGTON PA
15301-5864
US

IV. Provider business mailing address

217 JACKIE FRANK RD
SMITHFIELD PA
15478-1501
US

V. Phone/Fax

Practice location:
  • Phone: 724-228-5610
  • Fax: 724-222-7565
Mailing address:
  • Phone: 724-564-1811
  • Fax: 724-564-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0EG000199
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: