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General NPI Number Information
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NPI Number | 1144318841
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Entity Type | Individual
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Provider Name | LILIAN V. WALTER LICENSED OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5073 WATERWAY DR
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City | DUMFRIES
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State | VA
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Zip | 22025-1259
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Country | US
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Telephone | 703-580-7274
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Fax | 703-580-6945
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Provider Business Mailing Address
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Address Line | 5445 QUAINT DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4591
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Country | US
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Telephone | 703-583-9611
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Fax | 703-580-6945
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1101002209
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License Number State | VA
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