Provider Demographics
NPI:1326204041
Name:BARONDES, JENNIFER DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DALE
Last Name:BARONDES
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 1:791 FM 1103 STE 115
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3673
Mailing Address - Country:US
Mailing Address - Phone:210-659-3937
Mailing Address - Fax:
Practice Address - Street 1:791 FM 1103 STE 115
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3673
Practice Address - Country:US
Practice Address - Phone:210-659-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0815152W00000X
TX7899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty