Provider Demographics
NPI:1316424146
Name:DUONG, JACQUELINE ANN (OD)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANN
Last Name:DUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 FLORENCE STREET
Mailing Address - Street 2:#21C
Mailing Address - City:HENDERSON
Mailing Address - State:CO
Mailing Address - Zip Code:80640
Mailing Address - Country:US
Mailing Address - Phone:405-570-6752
Mailing Address - Fax:
Practice Address - Street 1:13599 E 104TH AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9419
Practice Address - Country:US
Practice Address - Phone:720-499-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist