Provider Demographics
NPI:1881634012
Name:BAILEY-MARTIN, JENNIFER M (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:BAILEY-MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:BAILY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3501 MEMORIAL PKWY SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5319
Mailing Address - Country:US
Mailing Address - Phone:256-533-0315
Mailing Address - Fax:256-533-0422
Practice Address - Street 1:3501 MEMORIAL PKWY SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5319
Practice Address - Country:US
Practice Address - Phone:256-533-0315
Practice Address - Fax:256-533-0422
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-816-TA-127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529904260-8937Medicaid
ALU57961Medicare UPIN
AL529904260-8937Medicaid