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Individual

JAY D EACKLES

Active
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Individual

JAY D EACKLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.ED.

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201000257
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0723576002
CIGNA PROVIDER#
VA
01
—
112848
ANTHEM PROVIDER#
VA
01
—
148932100
DEPT OF LABOR PROVIDER#
VA
01
—
51143
SENTARA/OPTIMA PROVIDER#
VA
01
—
540972387
AETNA/TRICARE PROVIDER#
VA
01
—
P00179152
MEDICARE RAILROAD PROVIDE
VA
Enumeration date
07/05/2006
Last updated
01/10/2019
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