Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618000007 | VA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 601001676 | VA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 601001676 | VA |
N | 152WP0200X | Pediatric Optomitrist | 601001676 | VA |
N | 152WX0102X | Occupational Vision | 601001676 | VA |
NPI | 1346226008 |
---|---|
Provider Name | Dr. Theresa L Batac |
First Address | Virginia Beach, VA 23454-1152 |
Second Address | Norfolk, VA 23505-3700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 16/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1801903745 | GROUP NPI (01) | |
51-0558604 | TAXID CORP (01) | |
9232559 | (05) | VA |
U43053 | (02) | VA |