Provider Demographics
NPI:1710997192
Name:CARGUS, JESSETTA (OD)
Entity Type:Individual
Prefix:
First Name:JESSETTA
Middle Name:
Last Name:CARGUS
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 1:500 FLINT PARC CIR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-6157
Mailing Address - Country:US
Mailing Address - Phone:205-422-6248
Mailing Address - Fax:205-477-0239
Practice Address - Street 1:1201 POWDER PLANT RD UNIT 15
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5247
Practice Address - Country:US
Practice Address - Phone:205-477-0229
Practice Address - Fax:205-477-0239
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS882TA441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003125OtherBCBS
AL000034301Medicare PIN
ALU74218Medicare UPIN