Provider Demographics
NPI:1417335175
Name:ALAQUINEZ, JACKLYN (OD)
Entity Type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:
Last Name:ALAQUINEZ
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 1:205B W WATER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4252
Mailing Address - Country:US
Mailing Address - Phone:830-896-2600
Mailing Address - Fax:
Practice Address - Street 1:301 10TH ST STE 3
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3197
Practice Address - Country:US
Practice Address - Phone:830-393-7744
Practice Address - Fax:830-393-7703
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8641TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351700501Medicaid