Provider Demographics
NPI:1073927869
Name:MANN, JESSICA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:MANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1209
Mailing Address - Country:US
Mailing Address - Phone:763-689-1494
Mailing Address - Fax:
Practice Address - Street 1:120 1ST AVE E
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1209
Practice Address - Country:US
Practice Address - Phone:763-689-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist