Provider Demographics
NPI:1679209027
Name:MISIOROWSKI, JESSICA CAMILLE (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:CAMILLE
Last Name:MISIOROWSKI
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 1:6767 COLLINS AVE APT 905
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3265
Mailing Address - Country:US
Mailing Address - Phone:773-318-0160
Mailing Address - Fax:
Practice Address - Street 1:44 BARKLEY CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7530
Practice Address - Country:US
Practice Address - Phone:239-338-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist