Provider Demographics
NPI:1740321710
Name:BRENNAN, JEAN STERRETT (OD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:STERRETT
Last Name:BRENNAN
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 1:47 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3253
Mailing Address - Country:US
Mailing Address - Phone:707-763-3103
Mailing Address - Fax:
Practice Address - Street 1:119 C ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3069
Practice Address - Country:US
Practice Address - Phone:707-766-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist