Provider Demographics
NPI:1407858962
Name:GRIMM, JESSICA JEAN (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JEAN
Last Name:GRIMM
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 1:5619 W LOOP 1604 N STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5795
Mailing Address - Country:US
Mailing Address - Phone:210-792-3089
Mailing Address - Fax:
Practice Address - Street 1:5619 W LOOP 1604 N STE 114
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5795
Practice Address - Country:US
Practice Address - Phone:210-792-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6743T152W00000X
TX6743TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist