Provider Demographics
NPI:1306907795
Name:BRENDING, JACQUELINE SUE (O D)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUE
Last Name:BRENDING
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17074 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4129
Mailing Address - Country:US
Mailing Address - Phone:281-338-8474
Mailing Address - Fax:281-338-4795
Practice Address - Street 1:17074 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4129
Practice Address - Country:US
Practice Address - Phone:281-338-8474
Practice Address - Fax:281-338-4795
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4230TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX061 1004643OtherEYEMED
TX15648OtherSPECTERA
TX35011OtherDAVIS VISION
TX760438604-00OtherSUPERIOR VISION
TX00E30TMedicare ID - Type Unspecified