MEDICARE: L & J VISION CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	1101003292	VA

General Provider Information

NPI Number	:	1043468986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L & J VISION CENTER, INC.

Provider Business Mailing Address
First Line	:	128 E LITTLE CREEK RD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23505-2503
Country	:	US
Telephone Number	:	757-480-1134
Fax Number	:	757-480-8655

Provider Business Practice Location Address
First Line	:	2201 UPTON DRIVE
Second Line	:	SUITE 902
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454
Country	:	US
Telephone Number	:	757-430-2860
Fax Number	:	757-430-2862

Authorized Official
Title or Position	:	OWNER
Name	:	LEANNE MARIE PERRY
Credential	:	A.B.O.C.
Telephone Number	:	757-480-1134

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	09/04/2008

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