MEDICARE: MS. JACQUELINE RENITA BROCK-CARTER

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	156FX1201X	Optometric Assistant Technician

General Provider Information

NPI Number	:	1396078531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE RENITA BROCK-CARTER

Provider Business Mailing Address
First Line	:	5028 FABLE ST
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-4019
Country	:	US
Telephone Number	:	240-838-1978
Fax Number	:

Provider Business Practice Location Address
First Line	:	5028 FABLE ST
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-4019
Country	:	US
Telephone Number	:	240-838-1978
Fax Number	:

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

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	09/04/2009

Similar Medicare Providers

1831773555 — ANNA BOWERS
Practice Location Address:

6210 BRANDT PIKE
HUBER HEIGHTS, OH
45424-4019

Practice Phone: 937-236-8630
Practice Fax:

1114957123 — URGENT CARE SPECIALISTS, LLC
Practice Location Address:

6210 BRANDT PIKE STE 102
HUBER HEIGHTS, OH
45424-4019

Practice Phone: 937-236-8635
Practice Fax: 937-236-8630

1912912049 — WALGREEN CO
Practice Location Address:

4019 METROPOLITAN PKWY
STERLING HEIGHTS, MI
48310-4517

Practice Phone: 586-446-8104
Practice Fax:

1902092430 — DR. AMY LYNN DILLREE PHD BCBA
Practice Location Address:

4019 LAKECLIFF DR
HARKER HEIGHTS, TX
76548-8608

Practice Phone: 254-833-3744
Practice Fax: 254-393-1253

1215213202 — SUDHA KUDAPA
Practice Location Address:

4019 METROPOLITAN PKWY
STERLING HEIGHTS, MI
48310-4517

Practice Phone: 586-446-8104
Practice Fax:

1790030385 — HOMETOWN URGENT CARE OF MICHIGAN, P.C.
Practice Location Address:

6210 BRANDT PIKE
HUBER HEIGHTS, OH
45424-4019

Practice Phone: 937-236-8630
Practice Fax: 937-236-8635

Directions to “ MS. JACQUELINE RENITA BROCK-CARTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.