MEDICARE: MS. JACQUELINE ANN DUONG 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
1	152W00000X	Optometrist	0003422	CO

General Provider Information

NPI Number	:	1316424146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE ANN DUONG OD

Provider Business Mailing Address
First Line	:	11250 FLORENCE STREET
Second Line	:	#21C
City	:	HENDERSON
State	:	CO
Zip	:	80640
Country	:	US
Telephone Number	:	405-570-6752
Fax Number	:

Provider Business Practice Location Address
First Line	:	13599 E 104TH AVE UNIT 400
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9419
Country	:	US
Telephone Number	:	720-499-8349
Fax Number	:

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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