Provider Demographics
NPI:1962983155
Name:THORNTON, JESSICA ANN (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:THORNTON
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 1:1345 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3236
Mailing Address - Country:US
Mailing Address - Phone:907-272-2557
Mailing Address - Fax:907-274-4932
Practice Address - Street 1:1345 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3236
Practice Address - Country:US
Practice Address - Phone:907-272-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK167293152W00000X
WA60875198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty