Provider Demographics
NPI:1740335470
Name:DOERR, JACQUELINE E (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:E
Last Name:DOERR
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 1:9501 BYEFORDE RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3602
Mailing Address - Country:US
Mailing Address - Phone:301-529-4170
Mailing Address - Fax:
Practice Address - Street 1:3204 TOWER OAKS BLVD STE 450
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4382
Practice Address - Country:US
Practice Address - Phone:240-669-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1720152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
009294M92Medicare ID - Type Unspecified
U89745Medicare UPIN