Individual
DR. JEFFREY IAN WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
17614 MAIN ST, DUMFRIES, VA 22026-2359
(703) 221-3575
(703) 221-4416
Mailing address
17614 MAIN ST, DUMFRIES, VA 22026-2359
(703) 221-3575
(703) 221-4416
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000150
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009203265
—
VA
Enumeration date
01/17/2006
Last updated
08/04/2009
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