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General NPI Number Information
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NPI Number | 1265651657
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Entity Type | Individual
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Provider Name | JACQUELINE JAQUINTO DIMARTINO OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 153 SMOKEY PARK HWY
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City | ASHEVILLE
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State | NC
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Zip | 28806-1166
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Country | US
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Telephone | 828-667-3211
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Fax | 828-670-1120
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Provider Business Mailing Address
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Address Line | 153 SMOKEY PARK HWY
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City | ASHEVILLE
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State | NC
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Zip | 28806-1167
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Country | US
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Telephone | 828-667-3211
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Fax | 828-670-1120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 975
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License Number State | NC
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