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General NPI Number Information
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NPI Number | 1679980858
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Entity Type | Individual
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Provider Name | JESSICA LAFFOON
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Gender | Female
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Dates
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Enumeration Date | 07/19/2014
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 12681 DORSETT RD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-2100
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Country | US
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Telephone | 314-786-3800
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Fax | 314-786-3801
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Provider Business Mailing Address
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Address Line | PO BOX 207158
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City | DALLAS
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State | TX
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Zip | 75320-7158
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Country | US
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Telephone | 636-200-4393
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Fax | 636-527-0766
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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 | 2014016610
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License Number State | MO
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