Provider Demographics
NPI:1629124250
Name:JESKIE, JOHN W (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:JESKIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NEW TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7966
Mailing Address - Country:US
Mailing Address - Phone:270-842-0383
Mailing Address - Fax:270-842-0485
Practice Address - Street 1:335 NEW TOWNE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7966
Practice Address - Country:US
Practice Address - Phone:270-842-0383
Practice Address - Fax:270-842-0485
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1015DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0063OtherSPECTERA
KY135412OtherCOLE MANAGE VISION
KY9361403OtherMEDICARE
KYVILLEOPTICALOtherVISION SERVICE PLAN
KY000000052153OtherANTHEM
KY39418OtherDAVIS VISION
KY126773001OtherDMERC
KY126773002OtherDMERC
KY000000215459OtherANTHEM
KY77010155Medicaid
KYKY1015OtherEYEMED VISION CARE
KY000000052153OtherANTHEM