Provider Demographics
NPI:1215032461
Name:JEFFRIES, LAICE LANETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAICE
Middle Name:LANETTE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAICE
Other - Middle Name:LANETTE
Other - Last Name:QUICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:23105 THREE NOTCH RD STE A
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2417
Practice Address - Country:US
Practice Address - Phone:301-863-2020
Practice Address - Fax:301-863-2417
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25101OtherSPECTERA
MD36787OtherAVESIS
MD25101OtherSPECTERA