Provider Demographics
NPI:1174975932
Name:KIENINGER, JESSICA (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KIENINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1846
Mailing Address - Country:US
Mailing Address - Phone:652-045-8587
Mailing Address - Fax:765-204-5850
Practice Address - Street 1:114 W 3RD ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1846
Practice Address - Country:US
Practice Address - Phone:765-204-5858
Practice Address - Fax:765-204-5850
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003980A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist