Provider Demographics
NPI:1407909104
Name:POSCOVER, JESSICA KATZ (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:KATZ
Last Name:POSCOVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:109 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2050
Mailing Address - Country:US
Mailing Address - Phone:617-395-8177
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:OPHTHALMOLOGY CC-5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3391
Practice Address - Fax:617-667-7092
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0336530Medicaid
MAW17426Medicare ID - Type Unspecified