Provider Demographics
NPI:1407181068
Name:HARPER, JENNIPHER RAE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIPHER
Middle Name:RAE
Last Name:HARPER
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 1:4265 FALLON ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6797
Mailing Address - Country:US
Mailing Address - Phone:406-465-0152
Mailing Address - Fax:
Practice Address - Street 1:4265 FALLON ST
Practice Address - Street 2:SUITE #1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6797
Practice Address - Country:US
Practice Address - Phone:406-465-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist