Provider Demographics
NPI:1982786604
Name:JESSE, NORMA J (OD)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:J
Last Name:JESSE
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 1:6621 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280-9748
Mailing Address - Country:US
Mailing Address - Phone:330-483-4035
Mailing Address - Fax:
Practice Address - Street 1:6621 CENTER RD
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:OH
Practice Address - Zip Code:44280-9748
Practice Address - Country:US
Practice Address - Phone:330-483-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4202 T-178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000137693OtherBLUE CROSS IDENTIFIER
OH54447OtherQUAL CHOICE IDENTIFIER
OH1982786604Medicare PIN
OHJEO673612Medicare ID - Type Unspecified
OH410029952Medicare PIN
OH1139220001Medicare NSC