Provider Demographics
NPI:1356645261
Name:GUNN, JACQUELINE DELL (OD)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DELL
Last Name:GUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2228 WILTON DRIVE
Mailing Address - Street 2:CHIC OPTIQUE
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305
Mailing Address - Country:US
Mailing Address - Phone:954-567-3937
Mailing Address - Fax:954-567-3993
Practice Address - Street 1:2228 WILTON DRIVE
Practice Address - Street 2:CHIC OPTIQUE
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305
Practice Address - Country:US
Practice Address - Phone:954-567-3937
Practice Address - Fax:954-567-3993
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-004134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist