MEDICARE: DR. OLIVIA ROCHELLE JAHNKE 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
1	152W00000X	Optometrist	18004029A	IN

General Provider Information

NPI Number	:	1831627116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVIA ROCHELLE JAHNKE OD

Provider Business Mailing Address
First Line	:	5611 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-3750
Country	:	US
Telephone Number	:	317-781-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	5611 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-3750
Country	:	US
Telephone Number	:	317-781-9090
Fax Number	:

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

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	06/19/2017

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