Provider Demographics
NPI:1063747244
Name:SCULLION, JILL M (OD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:SCULLION
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-4406
Mailing Address - Country:US
Mailing Address - Phone:910-612-8952
Mailing Address - Fax:
Practice Address - Street 1:1118 FALLS RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-4406
Practice Address - Country:US
Practice Address - Phone:252-544-9296
Practice Address - Fax:833-658-2615
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913404Medicaid
NC5913404Medicaid