MEDICARE: DR. JENNIFER DEE KILLIAN O.D

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
1	152W00000X	Optometrist	5584T2498	OH

General Provider Information

NPI Number	:	1508846072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER DEE KILLIAN O.D

Provider Business Mailing Address
First Line	:	36550 CHESTER RD
Second Line	:	#403
City	:	AVON
State	:	OH
Zip	:	44011-1091
Country	:	US
Telephone Number	:	716-812-7796
Fax Number	:

Provider Business Practice Location Address
First Line	:	7225 OLD OAK BLVD
Second Line	:	B303
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3339
Country	:	US
Telephone Number	:	440-243-7400
Fax Number	:	440-243-9034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/28/2008

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