Individual
DR. JENNIFER DENHARTOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
12695 UNIVERSITY AVE STE 170, CLIVE, IA 50325-8217
(515) 512-1444
(515) 512-1440
Mailing address
4702 148TH ST, URBANDALE, IA 50323-2074
(515) 210-9900
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02164
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0229344
—
IA
01
—
0893990001
DMERC
IA
01
—
24569
BC/BS INDIVIDUAL NUMBER
IA
Enumeration date
05/04/2006
Last updated
10/03/2018
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