Provider Demographics
NPI:1386217586
Name:JACQUES OPTOMETRY LLC
Entity Type:Organization
Organization Name:JACQUES OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-706-9896
Mailing Address - Street 1:1747 COUPRU CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-4558
Mailing Address - Country:US
Mailing Address - Phone:636-706-9896
Mailing Address - Fax:
Practice Address - Street 1:16972 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1200
Practice Address - Country:US
Practice Address - Phone:636-477-5187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty