MEDICARE: DR. JENNIFER L AYERS 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	3059-035	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3059-035	OTHER	WI	WI OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1932285400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L AYERS OD

Provider Business Mailing Address
First Line	:	5027 GREEN BAY RD.
Second Line	:	STE 110
City	:	KENOSHA
State	:	WI
Zip	:	53144
Country	:	US
Telephone Number	:	262-925-9251
Fax Number	:	262-925-9252

Provider Business Practice Location Address
First Line	:	5027 GREEN BAY RD STE 110
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53144-1771
Country	:	US
Telephone Number	:	262-925-9251
Fax Number	:	262-925-9252

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	10/06/2023

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