Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1777 | KS |
NPI | 1003016361 |
---|---|
Provider Name | Mr. Christopher J Jacquinot |
First Address | Pittsburg, KS 66762-2696 |
Second Address | Pittsburg, KS 66762-2620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 26/09/2012 |