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General NPI Number Information
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NPI Number | 1700775210
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Entity Type | Individual
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Provider Name | ISABEL THERESA VIRGILLE OD
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Gender | Female
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | GRAND FORKS AFB 1599 J STREET
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City | GRAND FORKS
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State | ND
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Zip | 58205
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Country | US
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Telephone | 701-747-5601
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 NE 201ST TER
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City | MIAMI
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State | FL
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Zip | 33179-5143
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Country | US
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Telephone |
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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 | 152W00000X
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License Number State | FL
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