Healthcare Provider Details

I. General information

NPI: 1033433925
Provider Name (Legal Business Name): JESSICA EVA VAN LOOVEREN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA EVA CHAN MD

II. Dates (important events)

Enumeration Date: 03/21/2010
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 OLD KEENE MILL RD STE 300B300
SPRINGFIELD VA
22152-1850
US

IV. Provider business mailing address

8136 OLD KEENE MILL RD STE B300
SPRINGFIELD VA
22152-1856
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-6111
  • Fax: 703-451-6247
Mailing address:
  • Phone: 703-451-6111
  • Fax: 703-451-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0079349
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number0101255636
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101255636
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: