Basic Information
| Provider Information | |||||||||
| NPI: | 1740436732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEGEWALD | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 402 | ||||||||
| Address2: | PMB 310 | ||||||||
| City: | DILLION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703686539 | ||||||||
| FaxNumber: | 9703686539 | ||||||||
| Practice Location | |||||||||
| Address1: | 358 BLUE RIVER PARKWAY | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SILVERTHORNE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038021022 | ||||||||
| FaxNumber: | 3038021024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 636 | NM | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2671 | CO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.