Individual
DR. JENNIFER ELAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
3560 PINE GROVE AVE, STE 366, PORT HURON, MI 48060-1994
(502) 759-1123
Mailing address
3560 PINE GROVE AVE, STE 366, PORT HURON, MI 48060-1994
(502) 759-1123
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1607DT
KY
152WC0802X
Corneal and Contact Management Optometrist
1607DT
KY
152WL0500X
Low Vision Rehabilitation Optometrist
1607DT
KY
Other
Enumeration date
09/01/2006
Last updated
06/21/2013
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