Provider Demographics
NPI:1730177312
Name:GINTER, JEWELL ELAINE (OD)
Entity type:Individual
Prefix:
First Name:JEWELL
Middle Name:ELAINE
Last Name:GINTER
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 1:6010 82ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-0822
Mailing Address - Country:US
Mailing Address - Phone:806-798-8820
Mailing Address - Fax:806-798-9754
Practice Address - Street 1:6010 82ND ST STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0822
Practice Address - Country:US
Practice Address - Phone:806-798-8820
Practice Address - Fax:806-798-9754
Is Sole Proprietor?:No
Enumeration Date:2005-10-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3035TG152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019525702Medicaid
TX80844QOtherBCBSTX
TXT95909Medicare UPIN