Provider Demographics
NPI:1265651657
Name:DIMARTINO, JACQUELINE JAQUINTO (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JAQUINTO
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SMOKEY PARK HWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1167
Mailing Address - Country:US
Mailing Address - Phone:828-667-3211
Mailing Address - Fax:828-670-1120
Practice Address - Street 1:153 SMOKEY PARK HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1166
Practice Address - Country:US
Practice Address - Phone:828-667-3211
Practice Address - Fax:828-670-1120
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC975156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician