Deola, Jerry J
Deola, Jerry J is an sole proprietor health care provider with primary practice located at 4460 Dale Blvd , Woodbridge VA 22193-2534. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Deola, Jerry J can be contacted via phone (703) 670-8085.Contact Information
Primary practice address
4460 Dale Blvd
Woodbridge VA 22193-2534
Phone: (703) 670-8085
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 0601000801 | Virginia |
Profile Details
| NPI number | 1093709594 |
|---|---|
| LBN Legal business name | Deola, Jerry J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 12th, 2005 |
| Last updated | Mar 21st, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093709594 | NPPES |
| Virginia | MEDICAID | 009204041 |
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