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General NPI Number Information
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NPI Number | 1225155229
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Entity Type | Organization
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Legal Business Name | PAUL LALLANDE, OD, PC, DOCTOR OF OPTOMETRY
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 125 SUFFOLK AVE
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City | RICHLANDS
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State | VA
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Zip | 24641-2434
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Country | US
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Telephone | 276-963-0808
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Fax | 276-963-7538
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Provider Business Mailing Address
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Address Line | 125 SUFFOLK AVE
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City | RICHLANDS
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State | VA
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Zip | 24641-2434
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Country | US
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Telephone | 276-963-0808
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Fax | 276-963-7538
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Authorized Official
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Title or Position | SECRETARY-TREASURER
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Name | MRS. MICHELLE CLERC LALLANDE
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Credential |
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Telephone | 276-963-0808
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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 | 0618000220
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License Number State | VA
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