Doctor Name: | DR. JACQUELYN GAYLE SHORT |
NPI Number: | 1588072003 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | O.D. |
License Number: | 3172 |
Business Practice Address: | 395 Forest Cir Unit 120 Jonesborough, TN - 376591439 |
Business Phone Number: | 4237537760 |
Business Fax Number: | |
Mailing Address: | 395 Forest Cir Unit 120, JONESBOROUGH |
State: | TN |
Postal Code: | 376591439 |
Phone Number: | 4237537760 |
Fax Number: | |
NPI Enumeration Date: | 07/28/2014 |
NPI Last Update Date: | 07/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 152WC0802X |
License Number: | 3172 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TN |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Optometrist |
Taxonomy Specialization: | Corneal and Contact Management |
Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |