Provider Demographics
NPI:1982012704
Name:JACQUELYN COLLINS, O.D., P.C.
Entity Type:Organization
Organization Name:JACQUELYN COLLINS, O.D., P.C.
Other - Org Name:DR. JACQUELYN COLLINS AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:COLLINS-FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OD
Authorized Official - Phone:256-830-9533
Mailing Address - Street 1:4925 UNIVERSITY DR NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1886
Mailing Address - Country:US
Mailing Address - Phone:256-830-9533
Mailing Address - Fax:256-830-0644
Practice Address - Street 1:4925 UNIVERSITY DR NW
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1886
Practice Address - Country:US
Practice Address - Phone:256-830-9533
Practice Address - Fax:256-830-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty