Provider Demographics
NPI:1295226215
Name:BODAMER, JESSICA LYNN (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:BODAMER
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 1:163 42ND ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201
Mailing Address - Country:US
Mailing Address - Phone:330-519-1418
Mailing Address - Fax:
Practice Address - Street 1:360 E WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-5004
Practice Address - Country:US
Practice Address - Phone:412-464-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006633152W00000X
PAOEG003516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist