Provider Demographics
NPI:1093800781
Name:CHRISTIAN-FRIEDRICHS, JILL E (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:E
Last Name:CHRISTIAN-FRIEDRICHS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:POPEROWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1975 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8388
Mailing Address - Country:US
Mailing Address - Phone:276-647-3937
Mailing Address - Fax:276-647-3990
Practice Address - Street 1:1975 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-8388
Practice Address - Country:US
Practice Address - Phone:276-647-3937
Practice Address - Fax:276-647-3990
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010070171Medicaid
VA138655OtherANTHEM
VA010070171Medicaid
VA005277F00Medicare PIN