Provider Demographics
NPI:1699765396
Name:STEJNA, JESSICA L (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:STEJNA
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 1:1900 CROWN COLONY DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0931
Mailing Address - Country:US
Mailing Address - Phone:617-472-5242
Mailing Address - Fax:617-770-2975
Practice Address - Street 1:1900 CROWN COLONY DR
Practice Address - Street 2:SUITE 301
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0931
Practice Address - Country:US
Practice Address - Phone:617-472-5242
Practice Address - Fax:617-770-2975
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4185152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0317799Medicaid
U79849Medicare UPIN
MAW17301Medicare ID - Type Unspecified