Provider Demographics
NPI:1699116848
Name:ELMORE, JESSICA CAITLIN (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:CAITLIN
Last Name:ELMORE
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 1:1657 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3425
Mailing Address - Country:US
Mailing Address - Phone:910-323-2100
Mailing Address - Fax:910-323-2165
Practice Address - Street 1:1657 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3425
Practice Address - Country:US
Practice Address - Phone:910-323-2100
Practice Address - Fax:910-323-2165
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2327152W00000X
SC1774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist