Provider Demographics
NPI:1154638591
Name:GARLICH, JACLYN E (OD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:E
Last Name:GARLICH
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 1:126 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2700
Mailing Address - Country:US
Mailing Address - Phone:617-426-0100
Mailing Address - Fax:
Practice Address - Street 1:126 HIGH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2700
Practice Address - Country:US
Practice Address - Phone:617-426-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5306152W00000X
MO2010022486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist