Organization
CLINIC OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER WENTWORTH M.D. (OPHTHALMOLOGIST)
(270) 780-0594
Entity
Organization
Contact information
Practice address
201 PARK ST, BOWLING GREEN, KY 42101-1759
(270) 780-0594
(270) 783-3361
Mailing address
201 PARK ST, BOWLING GREEN, KY 42101-1759
(270) 780-0594
(270) 783-3361
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
E82360
KY
332H00000X
Eyewear Supplier
Primary
102090
KY
Other
Enumeration date
03/29/2007
Last updated
05/07/2008
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