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General NPI Number Information
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NPI Number | 1316514250
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Entity Type | Individual
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Provider Name | ELICE GENIER O'HARA OD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 236 CARMICHAEL WAY
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City | CHESAPEAKE
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State | VA
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Zip | 23322-2185
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Country | US
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Telephone | 757-255-1330
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 BRANDON AVE
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City | NORFOLK
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State | VA
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Zip | 23507-1109
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Country | US
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Telephone | 757-803-7844
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618003032
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License Number State | VA
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