Provider Demographics
NPI:1689861239
Name:STEWART, JENNIFER LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:STEWART
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 1:12 OLD FIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06853-1119
Mailing Address - Country:US
Mailing Address - Phone:914-213-0550
Mailing Address - Fax:
Practice Address - Street 1:21 FOREST ST STE 8
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4766
Practice Address - Country:US
Practice Address - Phone:914-213-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007154152W00000X
CT2755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP3943726OtherOXFORD ID#
CT263271976OtherUHC
CT090002755CT02OtherBLUE CROSS ID
CT090002755CT02OtherBLUE CROSS ID
CT50NOREYECCT01OtherNORWALK EYECARE BLUE CROSS GROUP ID#
CT263271976OtherUHC