Individual
DR. CHANTAL H JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
14337 NEWBROOK DR STE 400, CHANTILLY, VA 20151-4259
(571) 512-5990
(571) 512-5989
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046.010234
IL
152W00000X
Optometrist
Primary
0618002953
VA
152W00000X
Optometrist
2009016926
MO
Other
Enumeration date
07/10/2009
Last updated
04/06/2022
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