Provider Demographics
NPI:1821153230
Name:OKEEFE, JILLIAN I (OD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:I
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:I
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 S STRATFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1856
Mailing Address - Country:US
Mailing Address - Phone:367-225-3463
Mailing Address - Fax:336-722-5348
Practice Address - Street 1:302 S STRATFORD RD STE B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1856
Practice Address - Country:US
Practice Address - Phone:367-225-3463
Practice Address - Fax:336-722-5348
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist