Individual
MRS. JENNIFER LEIGH PLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2550 S TELEGRAPH RD, SUITE 100, BLOOMFIELD HILLS, MI 48302-0950
(248) 258-9000
(248) 499-6372
Mailing address
2550 S TELEGRAPH RD, SUITE 100, BLOOMFIELD HILLS, MI 48302-0950
(248) 258-9000
(248) 499-6372
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5330000086
MI
152WC0802X
Corneal and Contact Management Optometrist
4901004123
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E04240
BLUE CROSS
MI
01
—
1GV09539
CIGAN HEALTHCARE
MI
01
—
JP004123
BLUE CROSS BLUE SHIELD
MI
Enumeration date
04/10/2007
Last updated
04/29/2015
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