Provider Demographics
NPI:1366778979
Name:ONEIL, JESSICA ROBYN (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROBYN
Last Name:ONEIL
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:PO BOX 207261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7261
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:
Practice Address - Street 1:775-1 WEST CORBETT AVE
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8563
Practice Address - Country:US
Practice Address - Phone:910-326-3050
Practice Address - Fax:910-326-7088
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1632152W00000X
NC2163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913956Medicaid
NC5913956Medicaid