Provider Demographics
NPI:1417110396
Name:DONAHUE, JACQUELINE M (OD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:DONAHUE
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 1:3333 QUALITY DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7985
Mailing Address - Country:US
Mailing Address - Phone:614-784-5331
Mailing Address - Fax:
Practice Address - Street 1:500 W PLUMB LN STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3688
Practice Address - Country:US
Practice Address - Phone:775-284-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV622OtherNEVADA STATE BOARD OF OPTOMETRY
NV1417110396Medicaid
NV4682730001Medicare NSC
NV1417110396Medicaid
NVBU803ZMedicare PIN