Provider Demographics
NPI:1659008589
Name:FARMER, JENNA LEE (OD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEE
Last Name:FARMER
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 1:1202 HARBIN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2384
Mailing Address - Country:US
Mailing Address - Phone:570-412-4489
Mailing Address - Fax:
Practice Address - Street 1:10930 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1958
Practice Address - Country:US
Practice Address - Phone:865-671-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist