Provider Demographics
NPI:1497873772
Name:SLUTSKY, JENNIFER LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:SLUTSKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:BOGDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 LEAD HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2949
Mailing Address - Country:US
Mailing Address - Phone:916-781-9120
Mailing Address - Fax:916-781-9065
Practice Address - Street 1:1400 LEAD HILL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2949
Practice Address - Country:US
Practice Address - Phone:916-781-9120
Practice Address - Fax:916-781-9065
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist