Provider Demographics
NPI:1245892645
Name:JENNINGS, JACQUELINE AGNES (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:AGNES
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1917 S HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8512
Mailing Address - Country:US
Mailing Address - Phone:502-225-0301
Mailing Address - Fax:502-222-0942
Practice Address - Street 1:1917 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8512
Practice Address - Country:US
Practice Address - Phone:502-225-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2145DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist