Jeffrey I Wynn OD LTD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000150 Issued in VA

Legal business name

JEFFREY I WYNN OD LTD

Practice address

17614 Main St
Dumfries, VA 22026-2359

Phone

(703) 221-3575

Fax

(703) 221-4416

NPI assigned

Jul 31, 2009

Last updated

Jul 31, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Ian Wynn, ODNPI 1154301190

Title

President

Phone

(703) 221-3575

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Ian Wynn, O.D.

  • Optometrist
  • Dumfries, VA
  • NPI 1154301190
  NPD Authorized official

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

{
    "created_epoch": "1248998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248998400000",
    "number": "1750512257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17614 MAIN ST",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220262359",
            "telephone_number": "703-221-3575",
            "fax_number": "703-221-4416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17614 MAIN ST",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220262359",
            "telephone_number": "703-221-3575",
            "fax_number": "703-221-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY I WYNN OD LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-31",
        "last_updated": "2009-07-31",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "IAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-221-3575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9203265",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "T21664",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; 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.