Healthcare Provider Details

I. General information

NPI: 1396528311
Provider Name (Legal Business Name): JESSI SAMPSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSI TYO

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 SKIDMORE LN
SUTTON WV
26601-9202
US

IV. Provider business mailing address

78 SKIDMORE LN
SUTTON WV
26601-9202
US

V. Phone/Fax

Practice location:
  • Phone: 304-202-6245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3026
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: