Provider Demographics
NPI:1598098477
Name:ESTREICHER, JACKIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:
Last Name:ESTREICHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:KORNBLUTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2019A HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4509
Mailing Address - Country:US
Mailing Address - Phone:954-922-5210
Mailing Address - Fax:
Practice Address - Street 1:2019A HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4509
Practice Address - Country:US
Practice Address - Phone:954-922-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007341152W00000X
FL4333152W00000X
PAOEG002328152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist