Provider Demographics
NPI:1497134399
Name:RAMEY, JENNIFER ELAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELAINE
Last Name:RAMEY
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7987
Practice Address - Street 1:3330 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4405
Practice Address - Country:US
Practice Address - Phone:208-746-2025
Practice Address - Fax:208-746-2025
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60644428152W00000X
IDODP-100359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2064914Medicaid
ID1497134399Medicaid