Provider Demographics
NPI:1760474662
Name:BIRSINGER, JERRI L (OD)
Entity Type:Individual
Prefix:DR
First Name:JERRI
Middle Name:L
Last Name:BIRSINGER
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 1:1781 JEFFCO BLVD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2713
Mailing Address - Country:US
Mailing Address - Phone:636-200-5008
Mailing Address - Fax:636-333-3093
Practice Address - Street 1:1781 JEFFCO BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2713
Practice Address - Country:US
Practice Address - Phone:636-200-5008
Practice Address - Fax:636-333-3093
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03357152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOBLC38016OtherBLUE CHOICE
MO410053835OtherPALMETTO GBA RAILROAD MED
MO108559OtherBC/BS ALLIANCE
MO342121OtherHEALTHLINK
MO60054OtherAETNA
MO114488OtherBLUE CROSS/ BLUE SHIELD
MO22-02004OtherUNITED HEALTHCARE
MO401501OtherGROUP HEALTH PLAN
MO114488OtherBLUE CROSS/ BLUE SHIELD