Provider Demographics
NPI:1942293196
Name:JENKINS, YVONNE M (OD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:M
Last Name:JENKINS
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 1:1426 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4927
Mailing Address - Country:US
Mailing Address - Phone:713-640-2020
Mailing Address - Fax:346-207-1485
Practice Address - Street 1:1426 W GRAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4927
Practice Address - Country:US
Practice Address - Phone:713-640-2020
Practice Address - Fax:346-207-1485
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5754TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156340501Medicaid
U89668Medicare UPIN
TX156340501Medicaid