Basic Information
| Provider Information | |||||||||
| NPI: | 1639334246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CATUNCAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 AIRPORT FWY | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | BEDFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760226018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172842964 | ||||||||
| FaxNumber: | 8172832760 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 AIRPORT FREEWAY, | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | BEDFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760226019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172842964 | ||||||||
| FaxNumber: | 8172832760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2008 | ||||||||
| LastUpdateDate: | 01/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7057TG | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 1639334246 | 01 | TX | INDIVIDUAL NPI | OTHER | 1801226238 | 01 | TX | GROUP NPI | OTHER | P01347885 | 01 | TX | RAILROAD MEDICARE PROVIDER PTAN | OTHER | DU9193 | 01 | TX | RAILROAD MEDICARE GROUP PTAN | OTHER | 7057TG | 01 | TX | LICENSE NUMBER | OTHER |