Provider Demographics
NPI:1053492140
Name:BIDOT, JESSICA (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BIDOT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CIUDAD JARDIN #36 CALLE YERBABUENA
Mailing Address - Street 2:
Mailing Address - City:GUIABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-215-1401
Mailing Address - Fax:787-712-0516
Practice Address - Street 1:PR 181RD KM 23.2
Practice Address - Street 2:BO CELADA
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-9649
Practice Address - Country:US
Practice Address - Phone:787-215-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist