Provider Demographics
NPI:1790753879
Name:EADDY, JENNIFER BUTTERFIELD (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BUTTERFIELD
Last Name:EADDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 SHAKER DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2406
Mailing Address - Country:US
Mailing Address - Phone:703-450-6996
Mailing Address - Fax:703-450-6996
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000989152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9381456OtherUHC
VA101713OtherBCBS
VA2427295OtherPHCS
VA2116982OtherMAMSI
VA9381456OtherUHC
VA2116982OtherMAMSI