Provider Demographics
NPI:1447483813
Name:GIRON, JESSICA N (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:N
Last Name:GIRON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2127 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1714
Mailing Address - Country:US
Mailing Address - Phone:505-890-3937
Mailing Address - Fax:505-890-5040
Practice Address - Street 1:2127 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1714
Practice Address - Country:US
Practice Address - Phone:505-890-3937
Practice Address - Fax:505-890-5040
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79136737Medicaid