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Individual

DR. JAYLENE K IVERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
1015 S LINCOLN RD, ESCANABA, MI 49829-2100
(906) 786-5181
Mailing address
1015 S LINCOLN RD, ESCANABA, MI 49829-2100
(906) 786-5181
(906) 786-7403

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004422
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1497792386
NPI GROUP
MI
05
1659572071
MI
01
900B110420
BLUE CROSS BLUE SHIELD
MI
01
CM1588
RAILROAD MEDICARE
MI
Enumeration date
05/31/2007
Last updated
06/22/2020
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