Provider Demographics
NPI:1588826424
Name:PARTLOW, JENNIFER DAWN (OD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAWN
Last Name:PARTLOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:NOWAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:411 WEST STATE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711
Mailing Address - Country:US
Mailing Address - Phone:828-357-5511
Mailing Address - Fax:828-357-5512
Practice Address - Street 1:411 W STATE ST STE B
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3344
Practice Address - Country:US
Practice Address - Phone:828-357-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588826424Medicaid
VAVV0171AMedicare PIN