Individual
JENELLE ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
156FC0800X
Contact Lens Technician/Technologist
2485-SC
OH
156FX1800X
Optician
Primary
2485-SC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306909577
—
OH
Enumeration date
02/13/2023
Last updated
02/13/2023
Update your record
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