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General NPI Number Information
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NPI Number | 1265681332
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Entity Type | Individual
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Provider Name | JA'NAI XZANA TELLIS FREDERICK O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 9440 IRON BRIDGE RD
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6601
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Country | US
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Telephone | 804-748-4877
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Fax | 804-796-9168
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Provider Business Mailing Address
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Address Line | PO BOX 1118
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City | CHESTERFIELD
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State | VA
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Zip | 23832-9123
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Country | US
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Telephone | 804-748-4877
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Fax | 804-796-9168
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001758
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License Number State | VA
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