Provider Demographics
NPI:1275734642
Name:MAJOR, JENNIFER HAM (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HAM
Last Name:MAJOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:HAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:STE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0838
Practice Address - Street 1:2256 W NINE MILE RD STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9471
Practice Address - Country:US
Practice Address - Phone:850-479-2020
Practice Address - Fax:850-479-2021
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019744100Medicaid
FL019744100Medicaid
FLBO390ZMedicare PIN