Jenisch, Daniel Albert

Jenisch, Daniel Albert is an sole proprietor health care provider with primary practice located at 2701 Main St Apartment # 91, Forest Grove OR 97116-1449. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Jenisch, Daniel Albert can be contacted via phone (503) 357-6257.

Contact Information

Primary practice address
2701 Main St Apartment # 91 Forest Grove OR 97116-1449
Phone: (503) 357-6257
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2056 Washington

Profile Details

NPI number 1528122405
LBN Legal business name Jenisch, Daniel Albert
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 21st, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528122405 NPPES
Washington MEDICAID 2016772

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