Provider Demographics
NPI:1801247614
Name:WADDELL, JACLYN ANN (OD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:ANN
Last Name:WADDELL
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:475 E BRUCETON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4503
Mailing Address - Country:US
Mailing Address - Phone:412-892-9767
Mailing Address - Fax:412-892-9768
Practice Address - Street 1:475 E BRUCETON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4503
Practice Address - Country:US
Practice Address - Phone:412-892-9767
Practice Address - Fax:412-892-9768
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG003177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist