Individual
REBECCA A JACQUEMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
11971 JAMES ST, HOLLAND, MI 49424-9610
(616) 395-0606
(616) 395-0070
Mailing address
11971 JAMES ST, HOLLAND, MI 49424-9610
(616) 395-0606
(616) 395-0070
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004404
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204829649
TAX ID
MI
05
—
5175716
—
MI
Enumeration date
12/29/2006
Last updated
08/16/2010
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