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General NPI Number Information
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NPI Number | 1629636402
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Entity Type | Organization
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Legal Business Name | JILLIAN IRIS OKEEFE OD PA
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 226 S ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2692
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Country | US
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Telephone | 336-333-2993
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Fax |
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Provider Business Mailing Address
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Address Line | 226 S ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2692
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Country | US
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Telephone | 336-333-2993
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | JILLIAN IRIS OKEEFE
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Credential | OD
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Telephone | 336-722-5346
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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 |
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License Number State |
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