Provider Demographics
NPI:1952407348
Name:PENN, JEFFREY M (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:PENN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17395 STATE HIGHWAY 249
Mailing Address - Street 2:SUITE 3I-2
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1179
Mailing Address - Country:US
Mailing Address - Phone:281-894-0011
Mailing Address - Fax:281-894-7799
Practice Address - Street 1:17395 STATE HIGHWAY 249
Practice Address - Street 2:SUITE 3I-2
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1179
Practice Address - Country:US
Practice Address - Phone:281-894-0011
Practice Address - Fax:281-894-7799
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2867TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F9988Medicare PIN