Healthcare Provider Details

I. General information

NPI: 1104609247
Provider Name (Legal Business Name): JOACHIM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9671 28TH BAY ST
NORFOLK VA
23518-1910
US

IV. Provider business mailing address

9671 28TH BAY ST
NORFOLK VA
23518-1910
US

V. Phone/Fax

Practice location:
  • Phone: 877-350-3399
  • Fax:
Mailing address:
  • Phone: 877-350-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN CANTRELL
Title or Position: MANAGER OF HEALTH SERVICES
Credential:
Phone: 561-208-8464