Provider Demographics
NPI:1164652772
Name:HORST, JACQUELYN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:MARIE
Last Name:HORST
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 1:4617 PERKIOMEN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3217
Mailing Address - Country:US
Mailing Address - Phone:484-651-1940
Mailing Address - Fax:
Practice Address - Street 1:4617 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3217
Practice Address - Country:US
Practice Address - Phone:484-651-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002229152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist