Provider Demographics
NPI:1760482228
Name:FENSKE, JOLENE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:
Last Name:FENSKE
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 1:2825 S GLENSTONE AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3728
Mailing Address - Country:US
Mailing Address - Phone:417-529-4511
Mailing Address - Fax:
Practice Address - Street 1:101 N RANGE LINE RD
Practice Address - Street 2:NORTHPARK EYECARE, STE.186
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-4118
Practice Address - Country:US
Practice Address - Phone:417-782-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001019421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist