Provider Demographics
NPI:1730749466
Name:BAILIN, JESSICA (OD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:BAILIN
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 1:251 LEAD KING DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 MAX DR STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9518
Practice Address - Country:US
Practice Address - Phone:303-688-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist