Healthcare Provider Details

I. General information

NPI: 1558373621
Provider Name (Legal Business Name): STEPHEN S JENNINGS OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HILLIARD RD SUITE 3
RICHMOND VA
23228-4525
US

IV. Provider business mailing address

2301 HILLIARD RD SUITE 3
RICHMOND VA
23228-4525
US

V. Phone/Fax

Practice location:
  • Phone: 804-262-5142
  • Fax: 804-262-6257
Mailing address:
  • Phone: 804-262-5142
  • Fax: 804-262-6257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN SELPH JENNINGS
Title or Position: SOLE MANGER, PRESIDENT, SECRETARY
Credential: O.D.
Phone: 804-262-5142