Individual
JAY CARL JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6525A W HOUGHTON LAKE DR, HOUGHTON LAKE, MI 48629-9789
(989) 422-5731
(989) 422-2534
Mailing address
6525A W HOUGHTON LAKE DR, HOUGHTON LAKE, MI 48629-9789
(989) 422-5731
(989) 422-2534
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003630
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1178430001
DMERC
MI
01
—
13146
SPECTERA
MI
01
—
13147
SPECTERA
MI
01
—
230603
NVA
MI
01
—
410036674
RAILROAD MEDICARE
MI
01
—
900022079
PRIORITY HEALTH
MI
01
—
900G210200
BLUE CROSS BLUE SHIELD
MI
05
—
943380772
—
MI
05
—
943380807
—
MI
01
—
MI3630
EYEMED
MI
01
—
P35872F
BLUE CARE NETWORK
MI
Enumeration date
06/07/2006
Last updated
06/29/2012
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