Provider Demographics
NPI:1154071447
Name:BECKMAN, JESSICA JOAN (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOAN
Last Name:BECKMAN
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 1:44139 MONTEREY AVE STE A100
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-8700
Mailing Address - Country:US
Mailing Address - Phone:760-469-5195
Mailing Address - Fax:760-779-0801
Practice Address - Street 1:44139 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-8700
Practice Address - Country:US
Practice Address - Phone:760-469-5195
Practice Address - Fax:760-779-0801
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty