Provider Demographics
NPI:1851733943
Name:HALL, JESSICA LAUREN (OD)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LAUREN
Last Name:HALL
Suffix:
Gender:F
Credentials:OD
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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 1:1415 WOOTEN LAKE RD NW STE 100
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-424-2020
Practice Address - Fax:770-424-8284
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2018-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT002770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist