MEDICARE: MR. CHRISTOPHER J JACQUINOT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1777	KS

General Provider Information

NPI Number	:	1003016361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER J JACQUINOT O.D.

Provider Business Mailing Address
First Line	:	101 W 29TH ST
Second Line	:	SUITE G
City	:	PITTSBURG
State	:	KS
Zip	:	66762-2696
Country	:	US
Telephone Number	:	620-235-1737
Fax Number	:	620-230-0358

Provider Business Practice Location Address
First Line	:	2521 N BROADWAY ST
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-2620
Country	:	US
Telephone Number	:	620-235-1737
Fax Number	:	620-230-0358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	09/26/2012

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