Healthcare Provider Details

I. General information

NPI: 1831006097
Provider Name (Legal Business Name): JENNA WILTSHIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 HIGHWAY 6 S STE 100
COLLEGE STATION TX
77845-8963
US

IV. Provider business mailing address

4075 HIGHWAY 6 S STE 100
COLLEGE STATION TX
77845-8963
US

V. Phone/Fax

Practice location:
  • Phone: 979-690-0888
  • Fax: 979-596-0086
Mailing address:
  • Phone: 979-690-0888
  • Fax: 979-596-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: