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General NPI Number Information
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NPI Number | 1376614404
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Entity Type | Individual
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Provider Name | DAVID MICHAEL JENNINGS JR. O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 305 N KEENE ST SUITE 205
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City | COLUMBIA
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State | MO
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Zip | 65201-6897
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Country | US
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Telephone | 573-499-9949
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N KEENE ST STE 205
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City | COLUMBIA
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State | MO
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Zip | 65201-6898
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Country | US
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Telephone | 573-499-9949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2002030491
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2252
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License Number State | OK
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