Active NPI
Jenelle Odom
- Optician
- Whitehall, OH
National Provider Identifier
1942907605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 2485-SC
- Practice address
- 3657 E Main St
Whitehall, OH 43213-2924 - Phone
- (614) 239-7829
- NPI assigned
- Feb 13, 2023
- Last updated
- Feb 13, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contact Lens Technician/Technologist | 156FC0800X | 2485-SC | OH | |
| Optician | 156FX1800X | 2485-SC | OH | Primary |
Addresses
Primary practice location
3657 E Main St
Whitehall, OH 43213-2924
Mailing address
3657 E Main St
Whitehall, OH 43213-2924
Phone (614) 239-7829
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306909577 | Medicaid | OH |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2485-SC | OH | MD | Contact Lens Technician/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676246400000",
"number": "1942907605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3657 E MAIN ST",
"city": "WHITEHALL",
"state": "OH",
"postal_code": "432132924",
"telephone_number": "614-239-7829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3657 E MAIN ST",
"city": "WHITEHALL",
"state": "OH",
"postal_code": "432132924",
"telephone_number": "614-239-7829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "JENELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-13",
"last_updated": "2023-02-13",
"certification_date": "2023-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "156FC0800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Contact Lens",
"state": "OH",
"license": "2485-SC",
"primary": false
},
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "OH",
"license": "2485-SC",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1306909577",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Whitehall, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.