Provider Demographics
NPI:1265455455
Name:PALOMBI, JENNIFER ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:PALOMBI
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 1:1520 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9592
Mailing Address - Country:US
Mailing Address - Phone:937-335-0250
Mailing Address - Fax:
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3281
Practice Address - Country:US
Practice Address - Phone:937-320-2020
Practice Address - Fax:937-320-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1265455455OtherMEDICARE RAILROAD
OH2974321Medicaid
OH1265455455OtherNPI
OH1932223476OtherOPTICAL SUPPLIER NPI
OH4066862Medicare PIN
OH1932223476OtherOPTICAL SUPPLIER NPI
OH0321780001Medicare NSC