Organization
JENNIFER DENHARTOG OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER DENHARTOG OD (OWNER/OD)
(515) 512-1444
Entity
Organization
Contact information
Practice address
12695 UNIVERSITY AVE STE 170, CLIVE, IA 50325
(515) 512-1444
(515) 512-1440
Mailing address
12695 UNIVERSITY AVE STE 170, CLIVE, IA 50325-8217
(515) 512-1444
(515) 512-1440
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1229344
—
IA
Enumeration date
04/07/2016
Last updated
09/11/2018
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