Provider Demographics
NPI:1083843163
Name:YORK, JENNIFER HERMETZ (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HERMETZ
Last Name:YORK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ALISON
Other - Last Name:HERMETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1815 HOSPITAL DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3425
Mailing Address - Country:US
Mailing Address - Phone:601-373-0714
Mailing Address - Fax:
Practice Address - Street 1:301 NORTHLAKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1720
Practice Address - Country:US
Practice Address - Phone:601-707-5255
Practice Address - Fax:601-707-5255
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist