Provider Demographics
NPI:1194182360
Name:MERWIN, JESSE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LYNN
Last Name:MERWIN
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0105
Mailing Address - Country:US
Mailing Address - Phone:814-221-6136
Mailing Address - Fax:
Practice Address - Street 1:5690 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3870
Practice Address - Country:US
Practice Address - Phone:814-375-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5123152W00000X
PAOEG003099152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist