Organization
H JACK FENNEL O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. H. JACK FENNEL O.D. (OWNER)
(530) 527-2211
Entity
Organization
Contact information
Practice address
1031 WASHINGTON ST, RED BLUFF, CA 96080-2746
(530) 527-2211
(530) 527-7412
Mailing address
1031 WASHINGTON ST, RED BLUFF, CA 96080-2746
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5114T
CA
152W00000X
Optometrist
8189T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0051140
—
CA
05
—
SD0081890
—
CA
Enumeration date
02/27/2007
Last updated
03/09/2010
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