Organization
DAVID C JENNINGS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID C JENNINGS OD (PRESIDENT)
(815) 718-0020
Entity
Organization
Contact information
Practice address
201 E MARKET ST, MORRISON, IL 61270-2854
(815) 718-0020
Mailing address
201 E MARKET ST, MORRISON, IL 61270-2854
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-006739
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060-002897
CORPORATION LICENSE NUMBE
IL
01
—
9826676
BLUE CROSS BLUE SHIELD
IL
01
—
D 5228-360-4
CORPORATION FILE NUMBER
IL
01
—
P00057517
RAILROAD MEDICARE
IL
Enumeration date
11/07/2006
Last updated
01/21/2014
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