Organization
STEPHEN S JENNINGS OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN SELPH JENNINGS O.D. (SOLE MEMBER, PRESIDENT,& SECRETARY)
(804) 730-4171
Entity
Organization
Contact information
Practice address
9291 LAUREL GROVE RD, MECHANICSVILLE, VA 23116-2969
(804) 730-4171
(804) 730-0438
Mailing address
9291 LAUREL GROVE RD, MECHANICSVILLE, VA 23116-2969
(804) 730-4171
(804) 730-0438
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010300258
—
VA
01
—
194180
ANTHEM
VA
Enumeration date
09/07/2006
Last updated
02/23/2010
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