Basic Information
| Provider Information | |||||||||
| NPI: | 1154654754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENEWEIN | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6960 SW 39TH ST | ||||||||
| Address2: | APT. 301 | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333142411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472247662 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 S UNIVERSITY DR | ||||||||
| Address2: | SANFORD ZIFF BLDG. 2ND FLOOR | ||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333282018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542624200 | ||||||||
| FaxNumber: | 9542621818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2009 | ||||||||
| LastUpdateDate: | 09/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC4454 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.