Individual
DR. JEETANDRA M. ATHELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
14161A ROBERT PARIS CT, CHANTILLY, VA 20151-4204
(703) 631-0014
(703) 449-8770
Mailing address
400 HOLIDAY CT 207, WARRENTON, VA 20186-4349
(540) 347-2217
(540) 347-0801
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000308
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
437150
ANTHEMBLUECROSSBLUESHIELD
VA
Enumeration date
06/01/2005
Last updated
07/08/2015
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