Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 0101269936 | VA |
N | 207WX0107X | Retina Specialist | 0101269936 | VA |
NPI | 1114345634 |
---|---|
Provider Name | Thomas Lee Jenkins |
First Address | Richmond, VA 23235-1989 |
Second Address | Richmond, VA 23235-1989 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 11/01/2021 |