Provider Demographics
NPI:1154738433
Name:BESEN, JESSICA MARY (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARY
Last Name:BESEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:MARY
Other - Last Name:BEAUREGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:615 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 GREENWICH AVE STE 10
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1882
Practice Address - Country:US
Practice Address - Phone:401-244-5186
Practice Address - Fax:401-396-2393
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5030152W00000X
CA33532152W00000X
RIODTA00558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist