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General NPI Number Information
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NPI Number | 1770275257
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Entity Type | Individual
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Provider Name | GAIL EMERSON FL LDO, VA LDO
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Gender | Female
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 14000 WORTH AVE
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4121
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Country | US
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Telephone | 703-491-0523
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Fax | 703-491-0531
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Provider Business Mailing Address
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Address Line | 14000 WORTH AVE
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4121
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Country | US
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Telephone | 703-491-0523
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Fax | 703-491-0531
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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 | DO6490
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1101004652
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License Number State | VA
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