Provider Demographics
NPI:1689891459
Name:BADILLO, JESSICA (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:BADILLO
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 1:5 PALACIOS DE ESCORIAL
Mailing Address - Street 2:APT 560
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-6014
Mailing Address - Country:US
Mailing Address - Phone:787-599-5084
Mailing Address - Fax:
Practice Address - Street 1:525 AVE FD ROOSEVELT SPC 55-56
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-753-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI45152W00000X
MI4901004883152W00000X
GAOPT003215152W00000X
OHOPT007016152W00000X
MDDA2480152W00000X
PR751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist