Provider Demographics
NPI:1629060124
Name:JASZKOWSKI, DONNA MICHELE (OD)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MICHELE
Last Name:JASZKOWSKI
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 1:6706 MARINETTE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4918
Mailing Address - Country:US
Mailing Address - Phone:713-777-5367
Mailing Address - Fax:713-777-0247
Practice Address - Street 1:6706 MARINETTE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4918
Practice Address - Country:US
Practice Address - Phone:713-777-5367
Practice Address - Fax:713-777-0247
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-09-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TX2925T152W00000X
CAOPT7432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019466401Medicaid