Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG003789 | PA |
NPI | 1003481391 |
---|---|
Provider Name | Dr. Tanya Marie Vigdal |
First Address | Vienna, VA 22182-3970 |
Second Address | Kennett Square, PA 19348-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2021 |
Last Update Date | 24/08/2021 |