Basic Information
| Provider Information | |||||||||
| NPI: | 1730177312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GINTER | ||||||||
| FirstName: | JEWELL | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6010 82ND ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794240822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067988820 | ||||||||
| FaxNumber: | 8067989754 | ||||||||
| Practice Location | |||||||||
| Address1: | 6010 82ND ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794240822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067988820 | ||||||||
| FaxNumber: | 8067989754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2005 | ||||||||
| LastUpdateDate: | 12/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 3035TG | TX | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | 3035TG | TX | N | Eye and Vision Services Providers | Optometrist | Pediatrics | 152W00000X | 3035TG | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 019525702 | 05 | TX | MEDICAID | 80844Q | 01 | TX | BCBSTX | OTHER |