MEDICARE: DR. JENNIFER RAE BAILEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18002774A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M400056211	OTHER	IN	MEDICARE PTAN

General Provider Information

NPI Number	:	1093796633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER RAE BAILEY O.D.

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	8170 OAKLANDON RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-9543
Country	:	US
Telephone Number	:	630-377-7722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	05/01/2024

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