Provider Demographics
NPI:1093880080
Name:BEARER, JESSICA MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARY
Last Name:BEARER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:MARY
Other - Last Name:WHITTEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:12606 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2447
Mailing Address - Country:US
Mailing Address - Phone:810-694-3652
Mailing Address - Fax:810-694-0963
Practice Address - Street 1:12606 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-694-3652
Practice Address - Fax:810-694-0963
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B513330OtherBCBS
MI4859224Medicaid
MI01003607OtherHEALTH PLUS OF MI
MI01003607OtherHEALTH PLUS OF MI
U97015Medicare UPIN