# JAY D EACKLES

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1568493807
- **Gender:** Man
- **Credential:** M.ED.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 2201000257 | VA | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 01/10/2019

## 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 |