Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1144438144 |
---|---|
Provider Name | Mr. David G Legrand |
First Address | Chesapeake, VA 23321-5518 |
Second Address | Chesapeake, VA 23321-5518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 12/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
196810 | ANTHEM HEALTH KEEPERS/BC (01) | VA |