Provider Demographics
NPI:1346299252
Name:JAEHNING, MARK W (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:JAEHNING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13893 E BELLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1170
Mailing Address - Country:US
Mailing Address - Phone:303-369-1020
Mailing Address - Fax:
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:155
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-369-1020
Practice Address - Fax:303-751-2020
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08010290Medicaid
MJ0016899OtherDEA
MJ0016899OtherDEA
CO08010290Medicaid