Provider Demographics
NPI:1922043496
Name:JAIKARAN, JENNIFER MARSHALL (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARSHALL
Last Name:JAIKARAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:KAREN
Other - Last Name:MARSHALL
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 1:3975 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4467
Practice Address - Country:US
Practice Address - Phone:678-624-7766
Practice Address - Fax:678-624-7775
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4030152W00000X
GAOPT 002111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA304425559AMedicaid
GAU97337Medicare UPIN
GA304425559AMedicaid