Individual
DR. JERRY J DEOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4460 DALE BLVD, WOODBRIDGE, VA 22193-2534
(703) 670-8085
Mailing address
4460 DALE BLVD, WOODBRIDGE, VA 22193-2534
(703) 670-8085
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0601000801
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009204041
—
VA
Enumeration date
09/12/2005
Last updated
03/21/2014
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