Provider Demographics
NPI:1821251760
Name:SCHARA, JESSICA LYNN (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SCHARA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:PRETTYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1502 WOODLANE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2221
Mailing Address - Country:US
Mailing Address - Phone:651-735-9550
Mailing Address - Fax:651-735-9322
Practice Address - Street 1:1502 WOODLANE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2221
Practice Address - Country:US
Practice Address - Phone:651-735-9550
Practice Address - Fax:651-735-9322
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3133152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3133OtherMINNESOTA STATE LICENSE
MN410003154OtherMEDICARE PTAN
MN973651062161OtherPREFERRED ONE
MN123023900Medicaid