Provider Demographics
NPI:1497974877
Name:KRUSE, JESSICA ANNE (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:KRUSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1546 STACY RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8726
Mailing Address - Country:US
Mailing Address - Phone:214-383-5400
Mailing Address - Fax:
Practice Address - Street 1:1546 STACY RD
Practice Address - Street 2:SUITE100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8726
Practice Address - Country:US
Practice Address - Phone:214-383-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6965TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50149380OtherDPS
TX50149380OtherDPS
TXMW1762005OtherDEA