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General NPI Number Information
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NPI Number | 1396373379
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Entity Type | Individual
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Provider Name | JENNA RAE STOFFEL OD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 6725 MIAMI AVE STE 101
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City | CINCINNATI
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State | OH
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Zip | 45243-3158
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Country | US
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Telephone | 513-561-7076
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Fax |
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Provider Business Mailing Address
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Address Line | 6725 MIAMI AVE STE 101
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City | CINCINNATI
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State | OH
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Zip | 45243-3158
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Country | US
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Telephone | 513-561-7076
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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 | OPT.007115
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License Number State | OH
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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 | 61062249
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD.OD.61062249
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License Number State | WA
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