Provider Demographics
NPI:1518220102
Name:MCCULLEN, JESSICA A (OD)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:MCCULLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1270
Mailing Address - Country:US
Mailing Address - Phone:641-774-7507
Mailing Address - Fax:641-774-0466
Practice Address - Street 1:147 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1218
Practice Address - Country:US
Practice Address - Phone:641-342-2737
Practice Address - Fax:641-342-4474
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist