Provider Demographics
NPI:1447411996
Name:NILSSON, JESSICA LIN (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LIN
Last Name:NILSSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:YUICHING
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2000 GENERAL BOOTH BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5876
Mailing Address - Country:US
Mailing Address - Phone:757-426-2020
Mailing Address - Fax:
Practice Address - Street 1:2000 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5876
Practice Address - Country:US
Practice Address - Phone:757-426-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist