MEDICARE: JESSICA ERIN WEINSTEIN M.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	207WX0107X	Retina Specialist (Ophthalmology) Physician	MD228545	OR
2	207W00000X	Ophthalmology Physician	MD60727229	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8966982	OTHER		MEDICARE PIN

General Provider Information

NPI Number	:	1609212448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ERIN WEINSTEIN M.D.

Provider Business Mailing Address
First Line	:	2450 12TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2152
Country	:	US
Telephone Number	:	503-371-4350
Fax Number	:	503-371-1124

Provider Business Practice Location Address
First Line	:	2450 12TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2152
Country	:	US
Telephone Number	:	503-371-4350
Fax Number	:	503-371-1124

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

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	04/06/2026

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