Healthcare Provider Details

I. General information

NPI: 1790633717
Provider Name (Legal Business Name): JESSICA WHITLEY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 OLD UNION TPKE
LANCASTER MA
01523-3029
US

IV. Provider business mailing address

479 OLD UNION TPKE
LANCASTER MA
01523-3029
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-3900
  • Fax: 978-537-6030
Mailing address:
  • Phone: 978-537-3900
  • Fax: 978-537-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8397
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: