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General NPI Number Information
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NPI Number | 1043468986
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Entity Type | Organization
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Legal Business Name | L & J VISION CENTER, INC.
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 2201 UPTON DRIVE SUITE 902
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-430-2860
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Fax | 757-430-2862
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Provider Business Mailing Address
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Address Line | 128 E LITTLE CREEK RD
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City | NORFOLK
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State | VA
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Zip | 23505-2503
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Country | US
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Telephone | 757-480-1134
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Fax | 757-480-8655
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Authorized Official
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Title or Position | OWNER
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Name | LEANNE MARIE PERRY
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Credential | A.B.O.C.
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Telephone | 757-480-1134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1101003292
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License Number State | VA
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