Provider Demographics
NPI:1932151677
Name:STROMBERG, JESSICA J (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:STROMBERG
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 1:104 A N ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-1227
Mailing Address - Country:US
Mailing Address - Phone:715-339-2040
Mailing Address - Fax:715-339-3885
Practice Address - Street 1:104 A N ARGYLE AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1227
Practice Address - Country:US
Practice Address - Phone:715-339-2040
Practice Address - Fax:715-339-3885
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2911-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1042683OtherPHYSICIANS PLUS
WIP00032150OtherRAIL ROAD MEDICARE
WI38618200Medicaid
U90666Medicare UPIN