Individual
JESSICA BROOKE TEGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
211 SE 5TH ST, MADRAS, OR 97741-1627
(541) 475-2020
(541) 923-3776
Mailing address
211 SE 5TH ST, MADRAS, OR 97741-1627
(541) 475-2020
(541) 475-6118
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3215AT
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
244121
—
OR
01
—
3215ATI
STATE LICENSE
OR
Enumeration date
07/10/2007
Last updated
03/16/2017
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