Provider Demographics
NPI:1801100995
Name:RATLIFF, JENNIFER ANN (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 MERCEDES ST
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2593
Mailing Address - Country:US
Mailing Address - Phone:817-249-4078
Mailing Address - Fax:817-249-4078
Practice Address - Street 1:300 MERCEDES ST
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2593
Practice Address - Country:US
Practice Address - Phone:817-249-4078
Practice Address - Fax:817-249-4078
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7640T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist