Provider Demographics
NPI:1083659254
Name:MALLINGER, JENNIFER C (OD CHARTERED)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:MALLINGER
Suffix:
Gender:F
Credentials:OD CHARTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 VILLAGE CENTER CIRCLE
Mailing Address - Street 2:STE. 10
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134
Mailing Address - Country:US
Mailing Address - Phone:702-240-2121
Mailing Address - Fax:702-240-5858
Practice Address - Street 1:1930 VILLAGE CENTER CIR STE 10
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6238
Practice Address - Country:US
Practice Address - Phone:702-240-2121
Practice Address - Fax:702-240-5858
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV34323Medicare PIN
NVU83733Medicare UPIN
NV4167720001Medicare NSC