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NPI Code Detail

MEDICARE: DR. JACQUELINE LA-SHAWN PIERRE OD

MEDICARE: DR. JACQUELINE LA-SHAWN PIERRE OD
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
1152W00000XOptometrist5254TGTX

General Provider Information

NPI Number : 1871572933
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE LA-SHAWN PIERRE OD
Provider Business Mailing Address
First Line : 2304 CAROLE ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-2267
Country : US
Telephone Number : 954-261-1026
Fax Number : 936-398-6912
Provider Business Practice Location Address
First Line : 4810 NORTH ST
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75965-1876
Country : US
Telephone Number : 936-569-2015
Fax Number : 936-398-6912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2006
Last Update Date : 08/27/2024

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