Provider Demographics
NPI:1659569606
Name:JENNIFER J. DOTTERWEICH, OD, PLLC
Entity Type:Organization
Organization Name:JENNIFER J. DOTTERWEICH, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOTTERWEICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-519-4208
Mailing Address - Street 1:243 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-1421
Mailing Address - Country:US
Mailing Address - Phone:585-519-4208
Mailing Address - Fax:
Practice Address - Street 1:243 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1421
Practice Address - Country:US
Practice Address - Phone:585-519-4208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006150-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU86791Medicare UPIN