Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618000728 | VA |
NPI | 1013003763 |
---|---|
Provider Name | Sarah C. Duval |
First Address | Richmond, VA 23219 |
Second Address | Richmond, VA 23219-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
277196 | ANTHEM PROVIDER NUMBER (01) | VA |