Healthcare Provider Details

I. General information

NPI: 1477502789
Provider Name (Legal Business Name): JAKELYN ANNETTE PARKER-HERRIOTT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W MONTGOMERY XRD
SAVANNAH GA
31406-3392
US

IV. Provider business mailing address

PO BOX 16143
SAVANNAH GA
31416-2843
US

V. Phone/Fax

Practice location:
  • Phone: 912-927-0707
  • Fax: 912-927-0677
Mailing address:
  • Phone: 912-927-0707
  • Fax: 912-927-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001403
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1075
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT001403
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1075
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT001403
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1075
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: