Provider Demographics
NPI:1619082062
Name:CLAIR-HORN, JACQUELINE ROSE (OD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ROSE
Last Name:CLAIR-HORN
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 1:880 GOLF VIEW DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8496
Mailing Address - Country:US
Mailing Address - Phone:541-779-3797
Mailing Address - Fax:541-842-2194
Practice Address - Street 1:880 GOLF VIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8496
Practice Address - Country:US
Practice Address - Phone:541-779-3797
Practice Address - Fax:541-842-2194
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3092T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269031Medicaid
OR117112Medicare PIN
OR269031Medicaid