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General NPI Number Information
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NPI Number | 1679209027
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Entity Type | Individual
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Provider Name | JESSICA CAMILLE MISIOROWSKI OD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 44 BARKLEY CIR
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City | FORT MYERS
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State | FL
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Zip | 33907-7530
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Country | US
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Telephone | 239-338-8681
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Fax |
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Provider Business Mailing Address
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Address Line | 6767 COLLINS AVE APT 905
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City | MIAMI BEACH
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State | FL
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Zip | 33141-3265
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Country | US
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Telephone | 773-318-0160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6140
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License Number State | FL
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