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General NPI Number Information
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NPI Number | 1568493807
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Entity Type | Individual
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Provider Name | JAY D EACKLES M.ED.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 808 TRITON CT STE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4520
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Country | US
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Telephone | 757-874-4665
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Fax | 757-874-1286
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Provider Business Mailing Address
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Address Line | 802 LOCKWOOD AVE SUITE C
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-4479
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Country | US
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Telephone | 757-874-4665
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Fax | 757-874-1286
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201000257
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License Number State | VA
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