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Individual

DR. JOHN ALEXANDER JENNINGS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
6815 118TH AVE, KENOSHA, WI 53142-8420
(262) 857-5600
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3312
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
100031400
MEDICAID LEGACY NUMBER
WI
05
100031400
WI
Enumeration date
05/28/2013
Last updated
03/02/2023
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