Provider Demographics
NPI:1588864706
Name:KELLERMAN, JESSICA SCHMIDT (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SCHMIDT
Last Name:KELLERMAN
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 1:14111 S HUTT RD
Mailing Address - Street 2:
Mailing Address - City:LONE JACK
Mailing Address - State:MO
Mailing Address - Zip Code:64070-8159
Mailing Address - Country:US
Mailing Address - Phone:816-206-2227
Mailing Address - Fax:
Practice Address - Street 1:900 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3744
Practice Address - Country:US
Practice Address - Phone:816-224-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1789152W00000X
MO2007018533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist