Active NPI
Jennifer Butterfield Eaddy, O.D.
- Optometrist
- Fort Belvoir, VA
National Provider Identifier
1790753879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0618000989
- Practice address
- 9300 Dewitt Loop
Fort Belvoir, VA 22060-5285 - Phone
- (571) 231-1600
- NPI assigned
- Mar 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | 0618000989 | VA | |
| Optometrist | 152W00000X | 0618000989 | VA | Primary |
Addresses
Primary practice location
9300 Dewitt Loop
Fort Belvoir, VA 22060-5285
Mailing address
1228 Shaker Dr
Herndon, VA 20170-2406
Phone (703) 450-6996
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9381456 | Other | VA | UHC |
| 101713 | Other | VA | BCBS |
| 2427295 | Other | VA | PHCS |
| 2116982 | Other | VA | MAMSI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0618000989 | VA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711670400000",
"number": "1790753879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1228 SHAKER DR",
"city": "HERNDON",
"state": "VA",
"postal_code": "201702406",
"telephone_number": "703-450-6996",
"fax_number": "703-450-6996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9300 DEWITT LOOP",
"city": "FORT BELVOIR",
"state": "VA",
"postal_code": "220605285",
"telephone_number": "571-231-1600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EADDY",
"first_name": "JENNIFER",
"middle_name": "BUTTERFIELD",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-14",
"last_updated": "2024-03-29",
"certification_date": "2023-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "VA",
"license": "0618000989",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0618000989",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "9381456",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "101713",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "2427295",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "2116982",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Belvoir, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.