Provider Demographics
NPI:1003016361
Name:JACQUINOT, CHRISTOPHER J (OD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J
Last Name:JACQUINOT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 29TH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2696
Mailing Address - Country:US
Mailing Address - Phone:620-235-1737
Mailing Address - Fax:620-230-0358
Practice Address - Street 1:2521 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2620
Practice Address - Country:US
Practice Address - Phone:620-235-1737
Practice Address - Fax:620-230-0358
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist