Healthcare Provider Details

I. General information

NPI: 1598985681
Provider Name (Legal Business Name): KERALAJOLISA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 GOLDEN ROCK SHOPPING CENTER SUITE 14 STERLING OPTICAL
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

3000 GOLDEN ROCK SHOPPING CENTER SUITE 14 STERLING OPTICAL
CHRISTIANSTED VI
00820
US

V. Phone/Fax

Practice location:
  • Phone: 340-773-8880
  • Fax: 340-773-8433
Mailing address:
  • Phone: 340-773-8880
  • Fax: 340-773-8433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number20
License Number StateVI

VIII. Authorized Official

Name: DR. LISA E ADAMS
Title or Position: OPTOMETRIST VICE PRESIDENT
Credential: OD
Phone: 340-773-8880