Provider Demographics
NPI:1629636402
Name:JILLIAN IRIS OKEEFE OD PA
Entity Type:Organization
Organization Name:JILLIAN IRIS OKEEFE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:OKEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-722-5346
Mailing Address - Street 1:226 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2692
Mailing Address - Country:US
Mailing Address - Phone:336-333-2993
Mailing Address - Fax:
Practice Address - Street 1:226 S ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2692
Practice Address - Country:US
Practice Address - Phone:336-333-2993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINSTON SALEM OPTOMETRIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821153230OtherNPI