Healthcare Provider Details

I. General information

NPI: 1649848250
Provider Name (Legal Business Name): MATHILDE WALLIS FRANKLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 GRANBY ST
NORFOLK VA
23504-1201
US

IV. Provider business mailing address

3921 GRANBY ST
NORFOLK VA
23504-1201
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number0101284922
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number2026-02391
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: