MEDICARE: JESSICA M CAMERON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901004220	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316921810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M CAMERON O.D.

Provider Business Mailing Address
First Line	:	20 S 10TH ST
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-1526
Country	:	US
Telephone Number	:	906-420-8322
Fax Number	:	906-420-8315

Provider Business Practice Location Address
First Line	:	20 S 10TH ST
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-1526
Country	:	US
Telephone Number	:	906-420-8322
Fax Number	:	906-420-8315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	10/20/2011

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