Provider Demographics
NPI:1689998171
Name:LACE, JACQUES SOARES (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:SOARES
Last Name:LACE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3131 CUSTER RD
Mailing Address - Street 2:S/ 155
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4419
Mailing Address - Country:US
Mailing Address - Phone:469-229-0341
Mailing Address - Fax:469-467-2459
Practice Address - Street 1:3131 CUSTER RD
Practice Address - Street 2:S/ 155
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4419
Practice Address - Country:US
Practice Address - Phone:469-229-0341
Practice Address - Fax:469-467-2459
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician