Provider Demographics
NPI:1144759150
Name:RIDDER, JESSICA LIN (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LIN
Last Name:RIDDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1083 N REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5138
Mailing Address - Country:US
Mailing Address - Phone:801-407-4779
Mailing Address - Fax:801-407-4778
Practice Address - Street 1:1083 N REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5138
Practice Address - Country:US
Practice Address - Phone:801-407-4779
Practice Address - Fax:801-407-4778
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10383779-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist