Individual
DR. JILL KRISTINE SHOWALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1500 GRAND CENTRAL AVE, SUITE 112, VIENNA, WV 26105-1079
(304) 295-5025
(304) 295-7178
Mailing address
1500 GRAND CENTRAL AVE, SUITE 112, VIENNA, WV 26105-1079
(304) 295-5025
(304) 295-7178
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4683 T1458
OH
152W00000X
Optometrist
Primary
939-OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810006845
—
WV
Enumeration date
01/19/2007
Last updated
05/26/2021
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