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Individual

JACOB RAY JENNESS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
9801 DUPONT AVE S STE 200, BLOOMINGTON, MN 55431-3200
(952) 888-5800
(952) 567-6156
Mailing address
2312 23RD ST, SPIRIT LAKE, IA 51360-1044
(712) 336-1960
(952) 567-6176

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3793
MN

Other

Enumeration date
06/02/2022
Last updated
10/02/2023
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