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General NPI Number Information
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NPI Number | 1568011021
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Entity Type | Individual
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Provider Name | JESSICA ANN KREINBRINK
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Gender | Female
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Dates
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Enumeration Date | 09/08/2019
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 4012 EASTON STA
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City | COLUMBUS
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State | OH
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Zip | 43219-6080
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Country | US
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Telephone | 614-476-2586
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 AFTON RD
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City | COLUMBUS
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State | OH
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Zip | 43221-1603
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Country | US
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Telephone | 419-969-9290
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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 | 006753
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License Number State | OH
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