Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2016023390 | MO |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2016023390 | MO |
NPI | 1043662927 |
---|---|
Provider Name | Dr. Jaclyn Oliver |
First Address | Fairlawn, OH 44333-9119 |
Second Address | Akron, OH 44320-4230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2016 |
Last Update Date | 04/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043662927 | (05) | MO |