Provider Demographics
NPI:1568956563
Name:LAMIGO, JACQUELYN ANINO (OD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:ANINO
Last Name:LAMIGO
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 1:101 W AMERICAN CANYON RD
Mailing Address - Street 2:SUITE 508-304
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503
Mailing Address - Country:US
Mailing Address - Phone:909-907-4081
Mailing Address - Fax:
Practice Address - Street 1:9350 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4613
Practice Address - Country:US
Practice Address - Phone:907-561-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33946TLG152W00000X
AK144582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist