Individual
ROGER C. JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
12 S DIVISION ST, DU QUOIN, IL 62832-1302
(618) 542-2157
(618) 542-6388
Mailing address
PO BOX 290, 12 S DIVISION STREET, DU QUOIN, IL 62832-0290
(618) 542-2157
(618) 542-6388
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
04600627
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0416560001
RR MEDICARE
IL
05
—
046006277
—
IL
Enumeration date
07/26/2006
Last updated
03/12/2008
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