Provider Demographics
NPI:1871649020
Name:JENNINGS EYE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:JENNINGS EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:573-499-9949
Mailing Address - Street 1:305 N KEENE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6897
Mailing Address - Country:US
Mailing Address - Phone:573-499-9949
Mailing Address - Fax:573-499-9950
Practice Address - Street 1:305 N KEENE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6897
Practice Address - Country:US
Practice Address - Phone:573-499-9949
Practice Address - Fax:573-499-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5914600001Medicare NSC
MO000014103Medicare ID - Type UnspecifiedGROUP IDENTIFIER
MO000014103Medicare PIN