Organization
JEFFREY I WYNN OD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY IAN WYNN OD (PRESIDENT)
(703) 221-3575
Entity
Organization
Contact information
Practice address
17614 MAIN ST, DUMFRIES, VA 22026-2359
(703) 221-3575
(703) 221-4416
Mailing address
17614 MAIN ST, DUMFRIES, VA 22026-2359
(703) 221-3575
(703) 221-4416
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000150
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9203265
—
VA
01
—
T21664
UPIN
—
Enumeration date
07/31/2009
Last updated
07/31/2009
Update your record
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