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NPI Code Detail

MEDICARE: JACQUELINE ELAINE BULLARD OD

MEDICARE: JACQUELINE ELAINE BULLARD 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
1152W00000XOptometrist064011144IL

General Provider Information

NPI Number : 1962927764
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE ELAINE BULLARD OD
Provider Business Mailing Address
First Line : 22 N JACKSON ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1425
Country : US
Telephone Number : 618-233-1270
Fax Number : 618-233-5939
Provider Business Practice Location Address
First Line : 22 N JACKSON ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1425
Country : US
Telephone Number : 618-233-1270
Fax Number : 618-233-5939
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2017
Last Update Date : 03/21/2024

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Directions to “ JACQUELINE ELAINE BULLARD OD” Practice Location

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