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NPI Code Detail

MEDICARE: LAUREN P RIVELLINO OD

MEDICARE: LAUREN P RIVELLINO OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0618001753VA

General Provider Information

NPI Number : 1891945697
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN P RIVELLINO OD
Provider Business Mailing Address
First Line : 17 N MEDICAL PARK DR
Second Line :
City : FISHERSVILLE
State : VA
Zip : 22939-2344
Country : US
Telephone Number : 540-213-7720
Fax Number : 540-213-7729
Provider Business Practice Location Address
First Line : 1500 COMMERCE RD
Second Line :
City : STAUNTON
State : VA
Zip : 24401-9032
Country : US
Telephone Number : 540-213-7720
Fax Number : 540-213-9441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2008
Last Update Date : 07/08/2020

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Directions to “ LAUREN P RIVELLINO OD” Practice Location

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