Provider Demographics
NPI:1093198996
Name:KOVACS, JESSAMYN (OD)
Entity Type:Individual
Prefix:
First Name:JESSAMYN
Middle Name:
Last Name:KOVACS
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 1:6 SEVEN PINES CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-3153
Mailing Address - Country:US
Mailing Address - Phone:608-444-1840
Mailing Address - Fax:
Practice Address - Street 1:822 PARK AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2206
Practice Address - Country:US
Practice Address - Phone:920-887-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3381-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist