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General NPI Number Information
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NPI Number | 1104609247
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Entity Type | Organization
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Legal Business Name | JOACHIM, LLC
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 9671 28TH BAY ST
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City | NORFOLK
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State | VA
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Zip | 23518-1910
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Country | US
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Telephone | 877-350-3399
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Fax |
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Provider Business Mailing Address
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Address Line | 9671 28TH BAY ST
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City | NORFOLK
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State | VA
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Zip | 23518-1910
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Country | US
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Telephone | 877-350-3399
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Fax |
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Authorized Official
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Title or Position | MANAGER OF HEALTH SERVICES
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Name | KIRSTEN CANTRELL
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Credential |
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Telephone | 561-208-8464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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