Provider Demographics
NPI:1023417144
Name:ROBAK, JACLYN KAY (OD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:KAY
Last Name:ROBAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:ROBAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 5996
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5996
Mailing Address - Country:US
Mailing Address - Phone:340-773-2020
Mailing Address - Fax:340-778-0977
Practice Address - Street 1:4500 SION FARM
Practice Address - Street 2:UNIT 2
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-773-2020
Practice Address - Fax:340-778-0977
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist