Provider Demographics
NPI:1336436344
Name:ARMSTRONG, JESSICA (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:ARMSTRONG
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:PO BOX 1798
Mailing Address - Street 2:DEPT 07-004
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-1798
Mailing Address - Country:US
Mailing Address - Phone:901-683-7255
Mailing Address - Fax:901-683-3523
Practice Address - Street 1:6465 N QUAIL HOLLOW RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1448
Practice Address - Country:US
Practice Address - Phone:901-683-7255
Practice Address - Fax:901-683-3523
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1022152W00000X
TN2991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528580Medicaid