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General NPI Number Information
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NPI Number | 1265660575
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Entity Type | Individual
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Provider Name | JENNIFER W SUN O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 24560 SOUTHPOINT DR STE 170
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City | ALDIE
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State | VA
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Zip | 20105-3504
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Country | US
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Telephone | 703-646-8002
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Fax | 703-646-8009
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Provider Business Mailing Address
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Address Line | 14729 SAINT GERMAIN DR
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City | CENTREVILLE
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State | VA
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Zip | 20121-2392
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Country | US
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Telephone | 413-222-8024
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 0618001860
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001860
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License Number State | VA
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