Provider Demographics
NPI:1770896367
Name:UNRUH, JESSICA LAUREN (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LAUREN
Last Name:UNRUH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:607 E RANDALL ST
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-8814
Practice Address - Country:US
Practice Address - Phone:620-327-2800
Practice Address - Fax:620-327-2055
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1884152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist