MEDICARE: DR. DOUGLAS N. JESKE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3087 TX	WA

General Provider Information

NPI Number	:	1235127093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS N. JESKE O.D.

Provider Business Mailing Address
First Line	:	6510 CAPITOL BLVD SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-5566
Country	:	US
Telephone Number	:	360-352-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 CAPITOL BLVD SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-5566
Country	:	US
Telephone Number	:	360-352-6060
Fax Number	:	360-357-7339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	09/01/2021

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