Provider Demographics
NPI:1184039752
Name:PIERCE, JACQUELINE (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:PIERCE
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 1:18631 N 19TH AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5299
Mailing Address - Country:US
Mailing Address - Phone:623-516-4710
Mailing Address - Fax:
Practice Address - Street 1:18631 N 19TH AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5299
Practice Address - Country:US
Practice Address - Phone:623-516-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist