H Jack Fennel O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5114T Issued in CA

Legal business name

H JACK FENNEL O.D.

Practice address

1031 Washington St
Red Bluff, CA 96080-2746

Phone

(530) 527-2211

Fax

(530) 527-7412

NPI assigned

Feb 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. H. Jack Fennel, O.D.

Title

Owner

Phone

(530) 527-2211

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268092800000",
    "number": "1164559084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 WASHINGTON ST",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 WASHINGTON ST",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802746",
            "telephone_number": "530-527-2211",
            "fax_number": "530-527-7412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "H JACK FENNEL O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2010-03-09",
        "status": "A",
        "authorized_official_last_name": "FENNEL",
        "authorized_official_first_name": "H.",
        "authorized_official_middle_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-527-2211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "5114T",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8189T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0081890",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0051140",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriel Mark Groppi
• Rachel M Gross, ASW
• Anne Grossman
• Gumm's Optical Shoppe Inc.
• Juanita Felisita Gutierrez
• Jebediah Morgan Hall, M.A.
• Shannon Marie Haller, PA
• Rachal Hambrock, OQP
• Teri Lynn Hamill, ASW
• Neesha Ray Hammercord, SUDRC

• Optometrist in Red Bluff, CA
• Providers in Red Bluff, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.