Provider Demographics
NPI:1487963567
Name:DEHAYES-RICE, JACLYN (OD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:DEHAYES-RICE
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 1:702 W DRAKE RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5563
Mailing Address - Country:US
Mailing Address - Phone:970-221-4811
Mailing Address - Fax:970-221-4815
Practice Address - Street 1:702 W DRAKE RD BLDG B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5563
Practice Address - Country:US
Practice Address - Phone:970-221-4811
Practice Address - Fax:970-221-4815
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT3012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty