Provider Demographics
NPI:1477592384
Name:HILDENBRAND, JESSICA D (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:D
Last Name:HILDENBRAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4445 LAKE FOREST DR
Mailing Address - Street 2:STE 600
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3744
Mailing Address - Country:US
Mailing Address - Phone:513-569-3741
Mailing Address - Fax:513-569-3941
Practice Address - Street 1:1945 CEI DRIVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3311
Practice Address - Country:US
Practice Address - Phone:513-569-3741
Practice Address - Fax:513-569-3941
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1410DT152W00000X
OH4938T1808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77540359Medicaid
OH2037114Medicaid
OH410037092OtherRAILROAD MEDICARE
IN200196940Medicaid
000000020793OtherBCBS
U71828Medicare UPIN
IN200196940Medicaid
OH2037114Medicaid