Provider Demographics
NPI:1457651010
Name:RENTERIA, JACQUELINE (OD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:RENTERIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:479 OLD UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-3029
Mailing Address - Country:US
Mailing Address - Phone:978-537-3900
Mailing Address - Fax:978-537-6030
Practice Address - Street 1:479 OLD UNION TPKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-3029
Practice Address - Country:US
Practice Address - Phone:978-537-3900
Practice Address - Fax:978-537-6030
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3561AT152W00000X
390200000X
MA5227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program