Provider Demographics
NPI:1255645230
Name:DEAKINS, JENNIFER LYNN (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:DEAKINS
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 1:2816 VINE ST
Mailing Address - Street 2:#359
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-4035
Mailing Address - Country:US
Mailing Address - Phone:832-671-9158
Mailing Address - Fax:
Practice Address - Street 1:3963 BOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3202
Practice Address - Country:US
Practice Address - Phone:817-237-7153
Practice Address - Fax:817-237-7123
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7594T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist