Organization
DR NEAL S JESSUP OPTOMETRIST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEAL S JESSUP O.D. (OWNER)
(540) 343-2197
Entity
Organization
Contact information
Practice address
2205 ORANGE AVE NE, ROANOKE, VA 24012-8305
(540) 343-2197
(540) 343-3575
Mailing address
PO BOX 488, VINTON, VA 24179-0488
(540) 343-2197
(540) 343-3575
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0601001553
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010220131
—
VA
Enumeration date
01/04/2007
Last updated
02/12/2020
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