Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 2020014960 | MO |
Y | 152W00000X | Optometrist | 3700 | TN |
NPI | 1013532480 |
---|---|
Provider Name | Dr. Jacqueline Rose Fiddler |
First Address | Arlington, TN 38002-4886 |
Second Address | Arlington, TN 38002-4886 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2020 |
Last Update Date | 23/08/2021 |