Provider Demographics
NPI:1457512782
Name:KOHN, JENNIFER LYNN (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:KOHN
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 1:70 E 68TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3506
Mailing Address - Country:US
Mailing Address - Phone:219-769-2606
Mailing Address - Fax:219-769-3884
Practice Address - Street 1:70 E 68TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3506
Practice Address - Country:US
Practice Address - Phone:219-769-2606
Practice Address - Fax:219-769-3884
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003509A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200902640Medicaid
IN436640FMedicare PIN
INP00732410Medicare PIN
IN496000FMedicare PIN
IN179800FMedicare PIN
IN495250FMedicare PIN