Provider Demographics
NPI:1093418584
Name:DINH, JESSICA QUYNH
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:QUYNH
Last Name:DINH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 DUNWOODY CHACE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:895 CANTON RD NE BLDG 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8935
Practice Address - Country:US
Practice Address - Phone:770-427-8111
Practice Address - Fax:770-427-6913
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003600152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist