Provider Demographics
NPI:1417050790
Name:SWITAK, JENNIFER ROBYN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROBYN
Last Name:SWITAK
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 1:16 CHARLESFORT PL
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1988
Mailing Address - Country:US
Mailing Address - Phone:843-422-5761
Mailing Address - Fax:843-757-9589
Practice Address - Street 1:104 BUCKWALTER PKWY
Practice Address - Street 2:UNIT 1 C
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4131
Practice Address - Country:US
Practice Address - Phone:843-757-9588
Practice Address - Fax:843-757-9589
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC26449OtherSPECTERA
SC50960OtherDAVIS
SCD13448Medicaid
SC552832OtherNVA
SCV06357Medicare UPIN
SC50960OtherDAVIS
SCD13448Medicaid