Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG002464 | PA |
NPI | 1013204619 |
---|---|
Provider Name | Mrs. Colleen Mary Rae-Jenkins |
First Address | York, PA 17402-9001 |
Second Address | York, PA 17403-5049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 01/06/2020 |