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General NPI Number Information
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NPI Number | 1710997192
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Entity Type | Individual
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Provider Name | JESSETTA CARGUS O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 1201 POWDER PLANT RD UNIT 15
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City | BESSEMER
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State | AL
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Zip | 35022-5247
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Country | US
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Telephone | 205-477-0229
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Fax | 205-477-0239
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Provider Business Mailing Address
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Address Line | 500 FLINT PARC CIR
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City | BESSEMER
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State | AL
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Zip | 35022-6157
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Country | US
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Telephone | 205-422-6248
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Fax | 205-477-0239
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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 | S882TA441
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License Number State | AL
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