Active NPI
Jerry Donn Jenks, O.D.
- Optometrist
- Platte City, MO
National Provider Identifier
1649296278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T02268
- Practice address
- 79 Maple Dr
Platte City, MO 64079-9640 - Phone
- (816) 858-3954
- Fax
- (816) 858-3954
- NPI assigned
- Jul 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02268 | MO | Primary |
Addresses
Primary practice location
79 Maple Dr
Platte City, MO 64079-9640
Mailing address
79 Maple Dr
PO Box 1008
Platte City, MO 64079-9640
Phone (816) 858-3954
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 310208160 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T02268 | MO | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1649296278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79 MAPLE DR",
"address_2": "PO BOX 1008",
"city": "PLATTE CITY",
"state": "MO",
"postal_code": "640799640",
"telephone_number": "816-858-3954",
"fax_number": "816-858-3954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79 MAPLE DR",
"city": "PLATTE CITY",
"state": "MO",
"postal_code": "640799640",
"telephone_number": "816-858-3954",
"fax_number": "816-858-3954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKS",
"first_name": "JERRY",
"middle_name": "DONN",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T02268",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "310208160",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Platte City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.