Provider Demographics
NPI:1801011218
Name:GARNER, JENNIFER KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KAY
Last Name:GARNER
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 1:3964 PARKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-3424
Mailing Address - Country:US
Mailing Address - Phone:940-383-1122
Mailing Address - Fax:
Practice Address - Street 1:1607 EAST MCKINNEY
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-4579
Practice Address - Country:US
Practice Address - Phone:940-566-3413
Practice Address - Fax:940-381-1828
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5047TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81394QOtherBLUE CROSS BLUE SHIELD
TX8G1742Medicare ID - Type Unspecified
TXU83957Medicare UPIN
TX00164PMedicare ID - Type UnspecifiedPROVIDER