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General NPI Number Information
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NPI Number | 1699742684
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Entity Type | Individual
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Provider Name | HEATHER M. JETTON O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 400 WESTHAMPTON STA
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City | RICHMOND
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State | VA
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Zip | 23226-3330
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Country | US
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Telephone | 804-287-4200
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Fax | 804-287-4210
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Provider Business Mailing Address
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Address Line | 400 WESTHAMPTON STA
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City | RICHMOND
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State | VA
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Zip | 23226-3330
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Country | US
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Telephone | 804-287-4200
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Fax | 804-287-4210
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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 | 0300000348
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License Number State | VT
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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 | 4543
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618002640
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8163077-9934
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License Number State | UT
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