Healthcare Provider Details

I. General information

NPI: 1245169655
Provider Name (Legal Business Name): JESSICA WILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6674 WINCHESTER BLVD
CANAL WINCHESTER OH
43110-2048
US

IV. Provider business mailing address

6674 WINCHESTER BLVD
CANAL WINCHESTER OH
43110-2048
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-6831
  • Fax:
Mailing address:
  • Phone: 614-833-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number10043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: