Provider Demographics
NPI:1700977899
Name:JARVIS, TRISIA L (OD)
Entity Type:Individual
Prefix:DR
First Name:TRISIA
Middle Name:L
Last Name:JARVIS
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 1:3800 N FAIRFAX DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203
Mailing Address - Country:US
Mailing Address - Phone:703-522-3454
Mailing Address - Fax:703-522-9636
Practice Address - Street 1:3800 N FAIRFAX DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-522-3454
Practice Address - Fax:703-522-9636
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
010175L49Medicare ID - Type Unspecified
U85674Medicare UPIN