Provider Demographics
NPI:1629177357
Name:WHITE, JENNIPHER LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIPHER
Middle Name:LYN
Last Name:WHITE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIPHER
Other - Middle Name:LYN
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:107 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:IN
Mailing Address - Zip Code:47060-1023
Mailing Address - Country:US
Mailing Address - Phone:812-637-1300
Mailing Address - Fax:859-525-8828
Practice Address - Street 1:2132 MALL ROAD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-525-2812
Practice Address - Fax:859-525-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1797DT152W00000X
OH6176152W00000X
IN18004458B152W00000X
NE1258152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Yes152W00000XEye and Vision Services ProvidersOptometrist