Jessica Noel Beaudoin, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618002667 Issued in VA

Practice address

1440 S Main St
Blacksburg, VA 24060-5568

Phone

(540) 953-2020

NPI assigned

Jun 20, 2018

Sex

Female

Sole proprietor

No

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

• Trend Eye Care II LLC

  • Optometrist
  • Philadelphia, PA
  • NPI 1285029223

  PA

  Medicare reassignment

Medicare fee-for-service enrollment

Enrolled in PA

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 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 20, 2018.

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1952895211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 S MAIN ST STE 100",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240605569",
            "telephone_number": "540-953-2020",
            "fax_number": "888-965-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240605568",
            "telephone_number": "540-953-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUDOIN",
        "first_name": "JESSICA",
        "middle_name": "NOEL",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA LICENSE",
            "identifier": "0618002667",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Bassler, PT, DPT
• Kristen Trump Battaglia, OTR/L
• Heather Lynn Bayless, NP-C
• Taylor Beasley, LPC
• Gregory Carl Beato, D.O.
• Ryan Everette Beaver
• Brenda Thompson Beck, LPC,LSATP
• Matthew Todd Beck, M.D.
• Geessiena Beckman
• Christopher A Belluzzo, D.C.

• All providers in Blacksburg, VA
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.