Provider Demographics
NPI:1639334246
Name:CATUNCAN, JENNIFER (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CATUNCAN
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 1:2400 AIRPORT FWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6018
Mailing Address - Country:US
Mailing Address - Phone:817-284-2964
Mailing Address - Fax:817-283-2760
Practice Address - Street 1:2400 AIRPORT FREEWAY,
Practice Address - Street 2:SUITE 140
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6019
Practice Address - Country:US
Practice Address - Phone:817-284-2964
Practice Address - Fax:817-283-2760
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7057TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1639334246OtherINDIVIDUAL NPI
TX1801226238OtherGROUP NPI
TXP01347885OtherRAILROAD MEDICARE PROVIDER PTAN
TXDU9193OtherRAILROAD MEDICARE GROUP PTAN
TX7057TGOtherLICENSE NUMBER
TXDU9193OtherRAILROAD MEDICARE GROUP PTAN