Provider Demographics
NPI:1790191641
Name:PULS, JESSICA (OD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:PULS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3424 MORMON COULEE ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6750
Mailing Address - Country:US
Mailing Address - Phone:608-788-4300
Mailing Address - Fax:608-788-4325
Practice Address - Street 1:3424 MORMON COULEE RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6702
Practice Address - Country:US
Practice Address - Phone:608-788-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3350-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist