Provider Demographics
NPI:1023141249
Name:JENNINGS, GLORIA C (OD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:C
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:C
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, PROF CORP
Mailing Address - Street 1:1717 W 86TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2050
Mailing Address - Country:US
Mailing Address - Phone:317-876-1112
Mailing Address - Fax:317-876-2187
Practice Address - Street 1:1717 W 86TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2050
Practice Address - Country:US
Practice Address - Phone:317-876-1112
Practice Address - Fax:317-876-2187
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001957A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist