Provider Demographics
NPI:1922402635
Name:JACLYN BUEHNER, O.D., INC.
Entity Type:Organization
Organization Name:JACLYN BUEHNER, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-773-1096
Mailing Address - Street 1:511 N HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3132
Mailing Address - Country:US
Mailing Address - Phone:843-899-3838
Mailing Address - Fax:
Practice Address - Street 1:511 N HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3132
Practice Address - Country:US
Practice Address - Phone:843-899-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty