Provider Demographics
NPI:1376899633
Name:TRICHEL, JESSICA RENEE (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:TRICHEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:GANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1727 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4648
Mailing Address - Country:US
Mailing Address - Phone:903-792-2020
Mailing Address - Fax:
Practice Address - Street 1:1727 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4648
Practice Address - Country:US
Practice Address - Phone:903-792-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2678152W00000X
TX8014T152W00000X
OK2730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8014TOtherSTATE LICENSE NUMBER
AR2730OtherSTATE LICENSE NUMBER
OK2730OtherSTATELICENSE
AR2730OtherSTATE LICENSE NUMBER
OKOKA105017Medicare PIN