Healthcare Provider Details

I. General information

NPI: 1225082217
Provider Name (Legal Business Name): WILLIAM L VELARDI JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 JEFFERSON AVE
NEWPORT NEWS VA
23604-1373
US

IV. Provider business mailing address

576 JEFFERSON AVE
NEWPORT NEWS VA
23604-1373
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7620
  • Fax: 757-314-7913
Mailing address:
  • Phone: 757-314-7620
  • Fax: 757-314-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number130001319
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: