Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618002464 | VA |
NPI | 1013145143 |
---|---|
Provider Name | Dr. Carissa Lee Novotny |
First Address | Fredericksburg, VA 22406-7000 |
Second Address | Fredericksburg, VA 22406-7000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 08/02/2018 |