Provider Demographics
NPI:1811249154
Name:VOSS, JENNING (OD)
Entity type:Individual
Prefix:
First Name:JENNING
Middle Name:
Last Name:VOSS
Suffix:
Gender:M
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:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0970
Mailing Address - Country:US
Mailing Address - Phone:307-885-3975
Mailing Address - Fax:307-885-9612
Practice Address - Street 1:50E 4TH AVE
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-885-3975
Practice Address - Fax:307-885-9612
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY404T152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program