Individual
DR. STEPHEN SELPH JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000068
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010300258
—
VA
05
—
010300274
—
VA
01
—
194180
ANTHEM
VA
01
—
194188
ANTHEM
VA
Enumeration date
08/10/2006
Last updated
02/23/2010
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