Provider Demographics
NPI:1386991404
Name:JAIN, SHILPA (OD)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHILPA
Other - Middle Name:
Other - Last Name:VERMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:1950 OLD GALLOWS RD
Practice Address - Street 2:SUITE 520
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3990
Practice Address - Country:US
Practice Address - Phone:703-847-8899
Practice Address - Fax:703-991-0514
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist