Healthcare Provider Details

I. General information

NPI: 1750406971
Provider Name (Legal Business Name): VERDI EYE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 GRANBY ST
NORFOLK VA
23505-3442
US

IV. Provider business mailing address

7312 GRANBY ST
NORFOLK VA
23505-3442
US

V. Phone/Fax

Practice location:
  • Phone: 757-583-5826
  • Fax: 757-588-2712
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number0101234127
License Number StateVA

VIII. Authorized Official

Name: LEE PIERCE
Title or Position: OPTICIAN
Credential:
Phone: 757-583-5826