Individual
JACOB SHUMWAY BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1124 10TH ST, ALAMOGORDO, NM 88310-6414
(575) 434-1200
Mailing address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1756
(503) 858-0991
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
697
NM
152W00000X
Optometrist
ODP-100283
TX
Other
Enumeration date
02/14/2013
Last updated
03/28/2018
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