Provider Demographics
NPI:1265437164
Name:JEROME, VALARIE SIMPSON (OD)
Entity type:Individual
Prefix:DR
First Name:VALARIE
Middle Name:SIMPSON
Last Name:JEROME
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VALARIE
Other - Middle Name:LYNN
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2215 MEMORIAL DR
Mailing Address - Street 2:#25
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-0983
Mailing Address - Country:US
Mailing Address - Phone:912-285-2021
Mailing Address - Fax:912-285-2558
Practice Address - Street 1:1111 E MAIN ST
Practice Address - Street 2:STE 120
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3500
Practice Address - Country:US
Practice Address - Phone:804-648-0900
Practice Address - Fax:804-648-4367
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010104017Medicaid
VA00W037D01Medicare ID - Type Unspecified