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NPI Code Detail

MEDICARE: JENNA RAE STOFFEL OD

MEDICARE: JENNA RAE STOFFEL OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT.007115OH
2152W00000XOptometrist61062249WA
3152W00000XOptometristOD.OD.61062249WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396373379
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA RAE STOFFEL OD
Provider Business Mailing Address
First Line : 6725 MIAMI AVE STE 101
Second Line :
City : CINCINNATI
State : OH
Zip : 45243-3158
Country : US
Telephone Number : 513-561-7076
Fax Number :
Provider Business Practice Location Address
First Line : 6725 MIAMI AVE STE 101
Second Line :
City : CINCINNATI
State : OH
Zip : 45243-3158
Country : US
Telephone Number : 513-561-7076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2020
Last Update Date : 06/06/2024

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Directions to “ JENNA RAE STOFFEL OD” Practice Location

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