Individual provider Active NPI

Jessica S Walter, OD

  • Optometrist
  • Worcester, MA
National Provider Identifier
1114404456
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5381 Issued in MA
Practice address
10 Lincoln SQ
Worcester, MA 01608-1135
Phone
(508) 373-5830
NPI assigned
Jul 19, 2018
Last updated
Mar 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5381 MA Primary
Optometrist 152W00000X 2206DT KY
Optometrist 152W00000X 4901005145 MI
Corneal and Contact Management Optometrist 152WC0802X 2206DT KY

Addresses

Primary practice location

10 Lincoln SQ
Worcester, MA 01608-1135

Mailing address

10 Lincoln SQ
Worcester, MA 01608-1135
Phone (508) 373-5830

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, KY, MA3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180808002983 MI Practitioner - Optometry 2163770009 Reassigns benefits to 1 organization
I20201104000430 KY Practitioner - Optometry 2163770009 Reassigns benefits to 1 organization
I20230907002970 MA Practitioner - Optometry 2163770009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Group practices
McPhs UniversityGroup PAC ID 2365682713, 19 clinicians

Practice addresses (Care Compare)

10 Lincoln SQ
Worcester, MA 01608-1135
Phone (508) 373-5830

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2206DTKYMDOptometrist
4901005145MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Big Sandy Health Care, Inc Current Accepting new patients
Big Sandy Health Care Inc CurrentSince Feb 12, 2021 Accepting new patients
Ferris State University CurrentSince Jul 3, 2018 Accepting new patients
Big Sandy Health Care Inc CurrentSince Feb 12, 2021 Accepting new patients
Ferris State University Optometrist CurrentSince Jul 3, 2018 Accepting new patients
McPhs University Optometrist CurrentSince Sep 5, 2023 Accepting new patients
Leominster Family Eyecare PLLC Optometrist PastSince Sep 5, 2023 Accepting new patients

Locations

178 Douglas Pkwy
Pikeville, KY 41501
Phone (606) 639-3135

1709 Ky Route 321
Ste 3
Prestonsburg, KY 41653
Phone (606) 886-8546

10 Lincoln Sq
Worcester, MA 01608
Phone (508) 373-5607

10 Lincoln Sq
Rm 112G
Worcester, MA 01608

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1114404456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 LINCOLN SQ",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081135",
            "telephone_number": "508-373-5830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 LINCOLN SQ",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081135",
            "telephone_number": "508-373-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "JESSICA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-19",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5381",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "2206DT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005145",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "KY",
            "license": "2206DT",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.