Provider Demographics
NPI:1144914771
Name:WALKOVIAK, JACLYN RUTH (ABCO)
Entity type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:RUTH
Last Name:WALKOVIAK
Suffix:
Gender:F
Credentials:ABCO
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Mailing Address - Street 1:10001 WOODLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2883
Mailing Address - Country:US
Mailing Address - Phone:281-419-6819
Mailing Address - Fax:281-419-7414
Practice Address - Street 1:10001 WOODLANDS PKWY
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2883
Practice Address - Country:US
Practice Address - Phone:281-419-6819
Practice Address - Fax:281-419-7414
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX180439156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician