MEDICARE: DR. JACQUELINE MICHELLE SCARBROUGH 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	4901004203	MI

General Provider Information

NPI Number	:	1285668863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE MICHELLE SCARBROUGH O.D.

Provider Business Mailing Address
First Line	:	3800 MELVIN RD
Second Line	:
City	:	PECK
State	:	MI
Zip	:	48466-9777
Country	:	US
Telephone Number	:	810-378-5232
Fax Number	:

Provider Business Practice Location Address
First Line	:	5590 MAIN ST.
Second Line	:	SUITE 1
City	:	LEXINGTON
State	:	MI
Zip	:	48450
Country	:	US
Telephone Number	:	810-359-2020
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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