Provider Demographics
NPI:1871572933
Name:PIERRE, JACQUELINE LA-SHAWN (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LA-SHAWN
Last Name:PIERRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:LASHAWN
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2304 CAROLE ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2267
Mailing Address - Country:US
Mailing Address - Phone:954-261-1026
Mailing Address - Fax:936-398-6912
Practice Address - Street 1:4810 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1876
Practice Address - Country:US
Practice Address - Phone:936-569-2015
Practice Address - Fax:936-398-6912
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5254TG152W00000X
MS742152W00000X
TX5254T152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics