Provider Demographics
NPI:1255675336
Name:STRAIT, JACQUELYN DENISE (OD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:DENISE
Last Name:STRAIT
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 1:14370 W. HWY 29
Mailing Address - Street 2:STE. 8
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642
Mailing Address - Country:US
Mailing Address - Phone:512-515-5100
Mailing Address - Fax:
Practice Address - Street 1:14370 WEST HIGHWAY 29
Practice Address - Street 2:SUITE 8
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642
Practice Address - Country:US
Practice Address - Phone:512-515-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5434TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist