Provider Demographics
NPI:1831502244
Name:BACKOWSKI, JENNA KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:KAY
Last Name:BACKOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:KAY
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2210 HIGHWAY 29 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3499
Mailing Address - Country:US
Mailing Address - Phone:320-219-6543
Mailing Address - Fax:320-219-6545
Practice Address - Street 1:2210 HIGHWAY 29 S
Practice Address - Street 2:SUITE 201
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3499
Practice Address - Country:US
Practice Address - Phone:320-219-6543
Practice Address - Fax:320-219-6545
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3385152W00000X
ND741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400143618Medicare PIN