Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 0618000190 | VA |
NPI | 1366448144 |
---|---|
Provider Name | Dr. Frank Benedict Villa II |
First Address | Lynchburg, VA 24502-4494 |
Second Address | Lynchburg, VA 24502-4494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2005 |
Last Update Date | 21/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0139570001 | ADMINA STAR (01) | VA |
260837 | ANTHEM (01) | VA |
410037410 | RAIL ROAD MEDICARE (01) | VI |
9230084 | (05) | VA |
T83542 | (02) | VA |