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NPI Code Detail

MEDICARE: DR. NORMA J JESSE O.D.

MEDICARE: DR. NORMA J JESSE 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
1152W00000XOptometrist4202 T-178OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000137693OTHEROHBLUE CROSS IDENTIFIER
254447OTHEROHQUAL CHOICE IDENTIFIER

General Provider Information

NPI Number : 1982786604
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NORMA J JESSE O.D.
Provider Business Mailing Address
First Line : 6621 CENTER RD
Second Line :
City : VALLEY CITY
State : OH
Zip : 44280-9748
Country : US
Telephone Number : 330-483-4035
Fax Number :
Provider Business Practice Location Address
First Line : 6621 CENTER RD
Second Line :
City : VALLEY CITY
State : OH
Zip : 44280-9748
Country : US
Telephone Number : 330-483-4035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 06/09/2014

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