Provider Demographics
NPI:1225000615
Name:HANNING, JAYEANNA RAE (OD)
Entity type:Individual
Prefix:DR
First Name:JAYEANNA
Middle Name:RAE
Last Name:HANNING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JAYEANNA
Other - Middle Name:RAE
Other - Last Name:MCMULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:265 MERCHANT WALK AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-6513
Practice Address - Country:US
Practice Address - Phone:434-760-2020
Practice Address - Fax:434-260-8018
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001369152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist