Provider Demographics
NPI:1124052261
Name:NORRIS, JESSICA W (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:W
Last Name:NORRIS
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 1:2715 WILLETTA ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3471
Mailing Address - Country:US
Mailing Address - Phone:541-926-5848
Mailing Address - Fax:541-926-2873
Practice Address - Street 1:2715 WILLETTA ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3471
Practice Address - Country:US
Practice Address - Phone:541-926-5848
Practice Address - Fax:541-926-2873
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2935AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275259Medicaid
ORU99806Medicare UPIN
ORR119109Medicare ID - Type Unspecified
OR0648670001Medicare NSC
OR275259Medicaid
ORP00140504Medicare PIN