Provider Demographics
NPI:1003048851
Name:BIRD, JENNIFER N (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:BIRD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6734 WESTHEIMER LAKES NORTH DR STE 111
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5713
Mailing Address - Country:US
Mailing Address - Phone:281-347-0004
Mailing Address - Fax:281-574-0030
Practice Address - Street 1:1355 E LEAGUE CITY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7095
Practice Address - Country:US
Practice Address - Phone:713-944-4182
Practice Address - Fax:832-932-3669
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7455T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB142479OtherINDIVIDUAL PTAN
TX7455TOtherTEXAS OPTOMETRY LICENSE
TX8L20738Medicare PIN