Provider Demographics
NPI:1821424722
Name:BEZNER, JESSICA M (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:BEZNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:STE 431
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-263-4631
Mailing Address - Fax:859-263-5694
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:STE 431
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-263-4631
Practice Address - Fax:859-263-5694
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1942DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK091500Medicare PIN