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General NPI Number Information
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NPI Number | 1891791521
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Entity Type | Organization
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Legal Business Name | GLAUCOMA LASER CENTER PC
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 160 KINGSLEY LN STE 300
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City | NORFOLK
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State | VA
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Zip | 23505-4600
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Country | US
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Telephone | 757-440-1144
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Fax | 757-440-1117
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Provider Business Mailing Address
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Address Line | 160 KINGSLEY LN STE 300
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City | NORFOLK
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State | VA
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Zip | 23505-4600
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Country | US
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Telephone | 757-440-1144
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Fax | 757-440-1117
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAWNIELLE J KERNER
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Credential | MD
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Telephone | 757-440-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | 0101052595
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License Number State | VA
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