Provider Demographics
NPI:1780664862
Name:UNGER, JENNIFER (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:UNGER
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 1:2705 S BERKLEY RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-8025
Mailing Address - Country:US
Mailing Address - Phone:765-453-2200
Mailing Address - Fax:765-453-1768
Practice Address - Street 1:2705 S BERKLEY RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902
Practice Address - Country:US
Practice Address - Phone:765-453-2200
Practice Address - Fax:765-453-1768
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003394A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200818480Medicaid
OH4147533Medicare PIN
V02478Medicare UPIN
OH4147534Medicare PIN
INP00337687Medicare PIN
INP00401766Medicare PIN
IN160450QMedicare PIN
OH4147532Medicare PIN
OH2517628Medicare PIN
IN452570009Medicare PIN
OH4147531Medicare PIN
IN186700DMedicare PIN