Provider Demographics
NPI:1740464734
Name:BUEHNER, JACLYN SUZANNE (OD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:SUZANNE
Last Name:BUEHNER
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 1:3959 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2839
Mailing Address - Country:US
Mailing Address - Phone:614-875-8373
Mailing Address - Fax:614-875-0974
Practice Address - Street 1:3959 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2839
Practice Address - Country:US
Practice Address - Phone:614-875-8373
Practice Address - Fax:614-875-0974
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist