Provider Demographics
NPI:1417060104
Name:PEEL, JESSICA LYNN (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:PEEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:SCHIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1331 24TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3860
Mailing Address - Country:US
Mailing Address - Phone:406-794-7656
Mailing Address - Fax:
Practice Address - Street 1:1331 24TH ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3860
Practice Address - Country:US
Practice Address - Phone:406-656-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2887AT152W00000X
MT787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1801037916OtherMEDICARE BILLING PROVIDER NPI
MT011002681OtherBILLING PTAN
MT1417060104Medicaid
MT011002682OtherRENDERING PTAN