Individual
DR. DIANE MARIE JESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1894 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3820
(636) 377-2054
(636) 377-2056
Mailing address
15933 CLAYTON RD, SUITE 201, BALLWIN, MO 63011-2172
(636) 200-4393
(636) 938-2650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2005019956
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063573400
—
MO
Enumeration date
12/12/2006
Last updated
10/28/2015
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