Provider Demographics
NPI:1497736102
Name:HUMMEL, JODI MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:MARIE
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JODI
Other - Middle Name:MARIE
Other - Last Name:HALSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3830 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8153
Mailing Address - Country:US
Mailing Address - Phone:231-929-3888
Mailing Address - Fax:231-929-4365
Practice Address - Street 1:3830 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8153
Practice Address - Country:US
Practice Address - Phone:231-929-3888
Practice Address - Fax:231-929-4365
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004107152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944976991Medicaid
MI900B86347OtherBCBS
MI1020070001OtherDMERC REG B
MIP00396057Medicare PIN
MICN1586Medicare PIN
MI0B86347003Medicare PIN