Provider Demographics
NPI:1700894920
Name:CO, JACQUELINE B (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:B
Last Name:CO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1381 LAKE PARK WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2372
Mailing Address - Country:US
Mailing Address - Phone:972-680-2020
Mailing Address - Fax:469-252-7293
Practice Address - Street 1:1381 LAKE PARK WAY STE 100
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2372
Practice Address - Country:US
Practice Address - Phone:972-680-2020
Practice Address - Fax:469-252-7293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9862207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG46518Medicare UPIN
TX00121DMedicare ID - Type Unspecified