Provider Demographics
NPI:1609604495
Name:SANTANA, JEHOVANY (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:JEHOVANY
Middle Name:
Last Name:SANTANA
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12605 ARBOR VIEW CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1401
Mailing Address - Country:US
Mailing Address - Phone:919-292-3548
Mailing Address - Fax:
Practice Address - Street 1:45415 DULLES CROSSING PLZ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-8921
Practice Address - Country:US
Practice Address - Phone:571-434-9422
Practice Address - Fax:571-434-9329
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004333156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician