Jacqueline Jiang Fredrick, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618001433 Issued in VA

Practice address

5511 Merchants View SQ
Haymarket, VA 20169-5439

Phone

(703) 659-4430

Fax

(703) 659-4438

NPI assigned

Mar 8, 2006

Last updated

Dec 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optometric Consultants of Virginia, Inc

  dba Eye & Vision Care

  • Optometrist
  • Chantilly, VA
  • NPI 1619285673
  NPD
• Optimum Optical LLC

  • Optician
  • Fairfax, VA
  • NPI 1588772024
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1407824394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5511 MERCHANTS VIEW SQ",
            "city": "HAYMARKET",
            "state": "VA",
            "postal_code": "201695439",
            "telephone_number": "703-659-4430",
            "fax_number": "703-273-0239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5511 MERCHANTS VIEW SQ",
            "city": "HAYMARKET",
            "state": "VA",
            "postal_code": "201695439",
            "telephone_number": "703-659-4430",
            "fax_number": "703-659-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICK",
        "first_name": "JACQUELINE",
        "middle_name": "JIANG",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010129460",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eulex Home Health Services LLC (Eulex Home Health Services)
• Eye Pro
• Family Counseling of Springfield, LLC
• Justin David Faul, DPM
• Joshua Fowler, LMT
• Functional Healthcare Solutions, LLC
• G and L Behavior Solutions
• Kara Therese Gallagher, DC
• Claudia Rubidia Gamez, LPC
• Dean F. Gawum, DNP, APRN, PMHNP-BC

• Optometrist in Haymarket, VA
• Providers in Haymarket, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.