Provider Demographics
NPI:1699183061
Name:RENARD, JENNIFER LARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LARIE
Last Name:RENARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LARIE
Other - Last Name:DOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1190 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1825
Mailing Address - Country:US
Mailing Address - Phone:509-662-9671
Mailing Address - Fax:096-629-6725
Practice Address - Street 1:1190 5TH ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1825
Practice Address - Country:US
Practice Address - Phone:509-622-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2808152W00000X
CA15365TLG152W00000X
WA60918984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist