Provider Demographics
NPI:1700987286
Name:LEMMON, JENNIFER B (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:LEMMON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 N CONGRESS ST
Mailing Address - Street 2:P O BOX 745
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1529
Mailing Address - Country:US
Mailing Address - Phone:803-628-5477
Mailing Address - Fax:803-628-5474
Practice Address - Street 1:46 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1529
Practice Address - Country:US
Practice Address - Phone:803-628-5477
Practice Address - Fax:803-628-5474
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12154Medicaid
SCD12154Medicaid