Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 0618000575 | VA |
NPI | 1093760159 |
---|---|
Provider Name | Dr. Iris L. Flores |
First Address | Winchester, VA 22603-1924 |
Second Address | Winchester, VA 22603-1924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 26/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
231505 | ANTHEM BCBS (01) | VA |
T31268 | (02) |