Healthcare Provider Details

I. General information

NPI: 1144438144
Provider Name (Legal Business Name): DAVID G LEGRAND B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 POPLAR HILL RD SUITE E
CHESAPEAKE VA
23321-5518
US

IV. Provider business mailing address

3800 POPLAR HILL RD SUITE E
CHESAPEAKE VA
23321-5518
US

V. Phone/Fax

Practice location:
  • Phone: 757-484-4900
  • Fax: 757-673-4722
Mailing address:
  • Phone: 757-484-4900
  • Fax: 215-496-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: