Provider Demographics
NPI:1114538402
Name:ALBERT, JACQUELINE NOEL (OD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:NOEL
Last Name:ALBERT
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 1:9908 SPRING OAK DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1728
Mailing Address - Country:US
Mailing Address - Phone:661-703-7990
Mailing Address - Fax:
Practice Address - Street 1:4105 EMPIRE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0637
Practice Address - Country:US
Practice Address - Phone:661-325-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist