Provider Demographics
NPI:1104113265
Name:JASINSKI, AMY ANNETTE (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANNETTE
Last Name:JASINSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:ANNETTE
Other - Last Name:CLEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2430 JUSTIN ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2430 JUSTIN ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077
Practice Address - Country:US
Practice Address - Phone:972-317-3937
Practice Address - Fax:972-317-2320
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7871T152W00000X
TX7871TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist