Provider Demographics
NPI:1497889067
Name:DELPLANCHE, JACQUELYN M (OD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:M
Last Name:DELPLANCHE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JACQUELYN
Other - Middle Name:M
Other - Last Name:WERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:20 NW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3507
Mailing Address - Country:US
Mailing Address - Phone:503-629-5200
Mailing Address - Fax:503-629-0419
Practice Address - Street 1:20 NW 185TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3507
Practice Address - Country:US
Practice Address - Phone:503-629-5200
Practice Address - Fax:503-629-0419
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3024ATI152WV0400X, 152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR154528OtherMEDICARE PTAN
OR115639OtherOMAP
OROOWFBPXAMedicare PIN
ORR154528OtherMEDICARE PTAN