Individual
DR. DANIEL ALBERT JENISCH SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D
Contact information
Practice address
2701 MAIN ST, APARTMENT # 91, FOREST GROVE, OR 97116-1449
(503) 357-6257
Mailing address
2701 MAIN ST, APARTMENT # 91, FOREST GROVE, OR 97116-1449
(503) 357-6257
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2056
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2016772
—
WA
Enumeration date
12/21/2006
Last updated
07/08/2007
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