Provider Demographics
NPI:1336701788
Name:JULIO, JACQUELINE ANNE ECALNIR (OD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE ANNE
Middle Name:ECALNIR
Last Name:JULIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2405 BAHAMA POINT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0965
Mailing Address - Country:US
Mailing Address - Phone:702-292-1988
Mailing Address - Fax:
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9125
Practice Address - Fax:702-791-9376
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1336701788Medicaid