Provider Demographics
NPI:1598364523
Name:TRISIA JARVIS OD PLLC
Entity type:Organization
Organization Name:TRISIA JARVIS OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-259-4817
Mailing Address - Street 1:1338 GARDEN WALL CIR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-2034
Mailing Address - Country:US
Mailing Address - Phone:571-699-6431
Mailing Address - Fax:
Practice Address - Street 1:WALMART VISION CENTER
Practice Address - Street 2:19360 COMPASS CREEK PARKWAY
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175
Practice Address - Country:US
Practice Address - Phone:703-259-4817
Practice Address - Fax:703-259-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty