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General NPI Number Information
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NPI Number | 1326992132
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Entity Type | Individual
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Provider Name | JESSICA SARAH CHAVEZ LDO
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Gender | Male
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Dates
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Enumeration Date | 02/26/2026
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | 4469 WASHINGTON RD
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City | EVANS
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State | GA
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Zip | 30809-3807
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Country | US
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Telephone | 706-854-7779
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Fax | 706-854-7668
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Provider Business Mailing Address
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Address Line | 4469 WASHINGTON RD
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City | EVANS
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State | GA
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Zip | 30809-3807
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Country | US
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Telephone | 706-854-7779
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Fax | 706-854-7668
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | LDO003098
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License Number State | GA
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