Individual
DR. JENNA LELSEY SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1 BANK AVE, KAUKAUNA, WI 54130-2581
(920) 766-2481
Mailing address
2331 WILLOW DROP WAY, OVIEDO, FL 32766-7083
(732) 684-2761
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3564-35
WI
152W00000X
Optometrist
OPC5544
FL
Other
Enumeration date
06/18/2018
Last updated
07/02/2019
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