Provider Demographics
NPI:1457639080
Name:CZERNY, JESSICA R (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:CZERNY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:PARTRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1236 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1533
Mailing Address - Country:US
Mailing Address - Phone:605-642-2645
Mailing Address - Fax:
Practice Address - Street 1:1236 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1533
Practice Address - Country:US
Practice Address - Phone:605-642-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD674152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist