Provider Demographics
NPI:1700192937
Name:DEGON, JENNIFER LYNN (ABOC)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DEGON
Suffix:
Gender:F
Credentials:ABOC
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Mailing Address - Street 1:306 N ELLEN ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:MO
Mailing Address - Zip Code:65459-6307
Mailing Address - Country:US
Mailing Address - Phone:573-596-0048
Mailing Address - Fax:573-596-0716
Practice Address - Street 1:126 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8952
Practice Address - Country:US
Practice Address - Phone:573-596-0048
Practice Address - Fax:573-596-0716
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician