Provider Demographics
NPI:1306233762
Name:DU, JESSICA (OD60565762)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DU
Suffix:
Gender:F
Credentials:OD60565762
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17334 SOUTHCENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17334 SOUTHCENTER PKWY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3316
Practice Address - Country:US
Practice Address - Phone:206-575-4500
Practice Address - Fax:206-575-3191
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD.60565762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist