Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101002209 | VA |
NPI | 1144318841 |
---|---|
Provider Name | Lilian V. Walter |
First Address | Woodbridge, VA 22193-4591 |
Second Address | Dumfries, VA 22025-1259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |