Provider Demographics
NPI:1942799234
Name:JENNA O'BRIEN O.D. PLLC
Entity Type:Organization
Organization Name:JENNA O'BRIEN O.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-429-1686
Mailing Address - Street 1:1038 S WHITE SANDS DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8202
Mailing Address - Country:US
Mailing Address - Phone:725-500-2493
Mailing Address - Fax:
Practice Address - Street 1:1038 S WHITE SANDS DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-8202
Practice Address - Country:US
Practice Address - Phone:725-500-2493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty