Provider Demographics
NPI:1538988035
Name:JENKINS, BERNADETTE LORI (OPTICIAN)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:LORI
Last Name:JENKINS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7494 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3577
Mailing Address - Country:US
Mailing Address - Phone:315-268-6921
Mailing Address - Fax:315-268-6923
Practice Address - Street 1:7494 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3577
Practice Address - Country:US
Practice Address - Phone:315-268-6921
Practice Address - Fax:315-268-6923
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008589-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician