Provider Demographics
NPI:1053726315
Name:EVANS, JACQUELINE CARMEN ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:CARMEN ELIZABETH
Last Name:EVANS
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 1:4875 S JASON ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-6414
Mailing Address - Country:US
Mailing Address - Phone:650-278-7610
Mailing Address - Fax:303-445-9468
Practice Address - Street 1:3301 TOWER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-3509
Practice Address - Country:US
Practice Address - Phone:720-374-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003588152W00000X
VT030.0133914152W00000X
VA0618002843152W00000X
MO2020002198152W00000X
MDTA2704152W00000X
FLTPOP38152W00000X
WI3643-35152W00000X
IA097350152W00000X
IL046011384152W00000X
NYTUV009025152W00000X
MN3673152W00000X
NE1572152W00000X
COOPT.0003054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist