Provider Demographics
NPI:1205361904
Name:PAPPAS, JESSICA S
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 W EAU GALLIE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1121
Practice Address - Country:US
Practice Address - Phone:202-544-9220
Practice Address - Fax:202-543-0656
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP1000378152W00000X
FLOPC5359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist