Provider Demographics
NPI:1659689479
Name:JENIFER W. AMBLER
Entity Type:Organization
Organization Name:JENIFER W. AMBLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:W
Authorized Official - Last Name:AMBLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:802-254-6900
Mailing Address - Street 1:PO BOX 8427
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05304-8427
Mailing Address - Country:US
Mailing Address - Phone:802-254-6900
Mailing Address - Fax:802-254-7610
Practice Address - Street 1:1222 PUTNEY RD
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9000
Practice Address - Country:US
Practice Address - Phone:802-254-6900
Practice Address - Fax:802-254-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty