Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 061800738 | VA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 0618000738 | VA |
N | 152WP0200X | Pediatric Optomitrist | 0618000738 | VA |
NPI | 1003802422 |
---|---|
Provider Name | Dr. Mary Lee Pemberton |
First Address | Waynesboro, VA 22980-8503 |
Second Address | Waynesboro, VA 22980-8503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 14/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159075 | SOUTHERN HEALTH (01) | VA |
466350 | ANTHEM BC/BS (01) | VA |
5612691 | CIGNA (01) | VA |
U94932 | (02) | VA |