Provider Demographics
NPI:1659521987
Name:CAMEN, JESSE A (OD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:A
Last Name:CAMEN
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 1:5702 LA JOLLA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7322
Mailing Address - Country:US
Mailing Address - Phone:619-997-8081
Mailing Address - Fax:
Practice Address - Street 1:5702 LA JOLLA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7322
Practice Address - Country:US
Practice Address - Phone:619-997-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist