Provider Demographics
NPI:1093001091
Name:WESTRUM, JESSE DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DAVID
Last Name:WESTRUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1916
Mailing Address - Country:US
Mailing Address - Phone:515-282-5005
Mailing Address - Fax:515-282-2010
Practice Address - Street 1:315E 5TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1916
Practice Address - Country:US
Practice Address - Phone:515-282-5005
Practice Address - Fax:515-282-2010
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist