Provider Demographics
NPI:1932293180
Name:COLLINS, JACQUELYN OLIVIA (OD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:OLIVIA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4925 UNIVERSITY DR. NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816
Mailing Address - Country:US
Mailing Address - Phone:256-830-9533
Mailing Address - Fax:256-830-0644
Practice Address - Street 1:4925 UNIVERSITY DRIVE NW
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816
Practice Address - Country:US
Practice Address - Phone:256-830-9533
Practice Address - Fax:256-830-0644
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B30-TA-735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist