Provider Demographics
NPI:1013204619
Name:RAE-JENKINS, COLLEEN MARY (OD)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARY
Last Name:RAE-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 1:3094 CAPE HORN RD
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9068
Mailing Address - Country:US
Mailing Address - Phone:717-246-3041
Mailing Address - Fax:717-244-5855
Practice Address - Street 1:3094 CAPE HORN RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-9068
Practice Address - Country:US
Practice Address - Phone:717-246-3041
Practice Address - Fax:717-244-5855
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist