Provider Demographics
NPI:1033819834
Name:CAMERON, JENNY LEE (LDO)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LEE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-3083
Mailing Address - Country:US
Mailing Address - Phone:419-599-1853
Mailing Address - Fax:419-599-1153
Practice Address - Street 1:1815 SCOTT ST
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1086
Practice Address - Country:US
Practice Address - Phone:419-599-1853
Practice Address - Fax:419-599-1153
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12123SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician