Healthcare Provider Details

I. General information

NPI: 1821251760
Provider Name (Legal Business Name): JESSICA LYNN SCHARA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYNN PRETTYMAN

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 WOODLANE DR
WOODBURY MN
55125-2221
US

IV. Provider business mailing address

1502 WOODLANE DR
WOODBURY MN
55125-2221
US

V. Phone/Fax

Practice location:
  • Phone: 651-735-9550
  • Fax: 651-735-9322
Mailing address:
  • Phone: 651-735-9550
  • Fax: 651-735-9322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3133
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: