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Individual

JAY D EACKLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.ED.

Contact information

Practice address
808 TRITON CT STE 100, NEWPORT NEWS, VA 23606-4520
(757) 874-4665
(757) 874-1286
Mailing address
802 LOCKWOOD AVE, SUITE C, NEWPORT NEWS, VA 23602-4479
(757) 874-4665
(757) 874-1286

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201000257
VA

Other

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
Enumeration date
07/05/2006
Last updated
01/10/2019
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