MEDICARE: JENNIFER S FELBINGER 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	5207	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000217306	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1629072244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER S FELBINGER O.D.

Provider Business Mailing Address
First Line	:	222 JEFFERSON ST
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1141
Country	:	US
Telephone Number	:	419-734-2106
Fax Number	:	419-734-3792

Provider Business Practice Location Address
First Line	:	222 JEFFERSON ST
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1141
Country	:	US
Telephone Number	:	419-734-2106
Fax Number	:	419-734-3792

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	01/27/2010

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