Provider Demographics
NPI:1427785054
Name:LIVERMONT, JESSICA (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:LIVERMONT
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 1:17816 E 626 RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-8757
Mailing Address - Country:US
Mailing Address - Phone:605-842-5132
Mailing Address - Fax:
Practice Address - Street 1:221 S FLORENCE AVE STE 150
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-7263
Practice Address - Country:US
Practice Address - Phone:918-341-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist