Provider Demographics
NPI:1245092527
Name:JENIFER E L WEBB OD, INC.
Entity type:Organization
Organization Name:JENIFER E L WEBB OD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:E L
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-967-5789
Mailing Address - Street 1:419 N SHORELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4605
Mailing Address - Country:US
Mailing Address - Phone:650-967-5789
Mailing Address - Fax:650-967-4106
Practice Address - Street 1:419 N SHORELINE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-4605
Practice Address - Country:US
Practice Address - Phone:652-096-7578
Practice Address - Fax:650-967-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty