MEDICARE: JESSICA SMALL PROCHILO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC6691	FL

General Provider Information

NPI Number	:	1760275531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SMALL PROCHILO

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2059 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6132
Country	:	US
Telephone Number	:	954-753-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	02/27/2026

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Directions to “ JESSICA SMALL PROCHILO ” Practice Location

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