Provider Demographics
NPI:1659723328
Name:SCHIFFBAUER, JESSICA G (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:G
Last Name:SCHIFFBAUER
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 1:3805B SPRING ST STE 140
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1642
Mailing Address - Country:US
Mailing Address - Phone:262-637-0500
Mailing Address - Fax:262-635-8027
Practice Address - Street 1:9916 75TH ST STE 101
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7583
Practice Address - Country:US
Practice Address - Phone:262-637-0500
Practice Address - Fax:262-635-8027
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3666152W00000X
VA0618002627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100193668Medicaid