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General NPI Number Information
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NPI Number | 1396848891
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Entity Type | Organization
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Legal Business Name | STEPHEN S JENNINGS OD LLC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 9291 LAUREL GROVE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2969
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Country | US
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Telephone | 804-730-4171
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Fax | 804-730-0438
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Provider Business Mailing Address
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Address Line | 9291 LAUREL GROVE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2969
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Country | US
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Telephone | 804-730-4171
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Fax | 804-730-0438
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Authorized Official
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Title or Position | SOLE MEMBER, PRESIDENT,& SECRETARY
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Name | DR. STEPHEN SELPH JENNINGS
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Credential | O.D.
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Telephone | 804-730-4171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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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 |
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License Number State |
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