Provider Demographics
NPI:1811980964
Name:BULMANN, JENNIFER K (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:BULMANN
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 1:3500 W PETERSON AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3306
Mailing Address - Country:US
Mailing Address - Phone:773-588-3090
Mailing Address - Fax:773-588-3210
Practice Address - Street 1:3500 W PETERSON AVE
Practice Address - Street 2:STE 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3306
Practice Address - Country:US
Practice Address - Phone:773-588-3090
Practice Address - Fax:773-588-3210
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2163152W00000X
MO2011037755152W00000X
IL046009248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3946149Medicaid
ILP01342597OtherRAILROAD MEDICARE NUMBER
MO1811980964Medicaid
TN2163OtherOD
MB1096646OtherDEA
U92841Medicare UPIN
ILF400116443Medicare PIN
MO067820029Medicare PIN
TN2163OtherOD
ILP01342597OtherRAILROAD MEDICARE NUMBER
MB1096646OtherDEA
MO1811980964Medicaid
TN3946149Medicaid
ILF400116441Medicare PIN
MO991630010Medicare PIN