| Doctor Name: | MS. JACQUELINE RENITA BROCK-CARTER |
| NPI Number: | 1396078531 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 5028 Fable St Capitol Heights, MD - 207434019 |
| Business Phone Number: | 2408381978 |
| Business Fax Number: | |
| Mailing Address: | 5028 Fable St, CAPITOL HEIGHTS |
| State: | MD |
| Postal Code: | 207434019 |
| Phone Number: | 2408381978 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2009 |
| NPI Last Update Date: | 09/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1201X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optometric Assistant |
| Taxonomy Definition: | |