Basic Information
| Provider Information | |||||||||
| NPI: | 1740335470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOERR | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9501 BYEFORDE RD | ||||||||
| Address2: | |||||||||
| City: | KENSINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208953602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015294170 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9501 BYEFORDE RD | ||||||||
| Address2: | |||||||||
| City: | KENSINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208953602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015294170 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA1720 | MD | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.