Provider Demographics
NPI:1356587976
Name:BOGGIE, JENNIFER LYN (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYN
Last Name:BOGGIE
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 1:468 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9225
Mailing Address - Country:US
Mailing Address - Phone:802-748-3536
Mailing Address - Fax:802-748-4838
Practice Address - Street 1:468 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9225
Practice Address - Country:US
Practice Address - Phone:802-748-3536
Practice Address - Fax:802-748-4838
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5132152W00000X
VT030.0133982152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist