Provider Demographics
NPI:1396368718
Name:DANKER, JILL CARLENE (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:CARLENE
Last Name:DANKER
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 1:399 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4143
Mailing Address - Country:US
Mailing Address - Phone:740-387-8414
Mailing Address - Fax:
Practice Address - Street 1:905 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2663
Practice Address - Country:US
Practice Address - Phone:419-562-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist