Provider Demographics
NPI:1124228267
Name:DEHNE, JEANNIE MAUREEN (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:MAUREEN
Last Name:DEHNE
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2677
Mailing Address - Country:US
Mailing Address - Phone:605-338-7104
Mailing Address - Fax:
Practice Address - Street 1:5116 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2677
Practice Address - Country:US
Practice Address - Phone:605-338-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist