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General NPI Number Information
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NPI Number | 1659572071
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Entity Type | Individual
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Provider Name | JAYLENE K IVERSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 1015 S LINCOLN RD
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City | ESCANABA
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State | MI
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Zip | 49829-2100
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Country | US
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Telephone | 906-786-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 S LINCOLN RD
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City | ESCANABA
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State | MI
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Zip | 49829-2100
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Country | US
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Telephone | 906-786-5181
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Fax | 906-786-7403
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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 | 4901004422
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License Number State | MI
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