Provider Demographics
NPI:1548600414
Name:ELDER, JENNIFER TAYLOR (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TAYLOR
Last Name:ELDER
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 1:180 OLD HICKORY BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2500
Mailing Address - Country:US
Mailing Address - Phone:731-661-2750
Mailing Address - Fax:
Practice Address - Street 1:180 OLD HICKORY BLVD STE L
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2500
Practice Address - Country:US
Practice Address - Phone:731-661-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009366Medicaid
TN103I908576Medicare PIN
TN3724242Medicare PIN
TN0137930006Medicare NSC