MEDICARE: JOEL KENNETH LALL-TRAIL M.D.

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	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician	0101227716	VA
2	207W00000X	Ophthalmology Physician	0101227716	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	180040530	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0800727	OTHER	VA	UNITED HEALTH CARE PROV
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	216425	OTHER	VA	ANTHEM PROV #
4	541299712	OTHER	VA	SUPERIOR VISION PROV #
5	600215467	OTHER	VA	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	216425	OTHER	VA	HEALTHKEEPERS PROV #
8	541299712	OTHER	VA	PHCS PROVIDER #
9	28935	OTHER	VA	OPTIMA PROV #
10	541299712	OTHER	VA	FIRST HEALTH PROV #
11	6301100	OTHER	VA	VA PREMIER PROV #
13	541299712	OTHER	VA	VA HEALTH NETWORK
14	7013145	OTHER	VA	AETNA PROV #

General Provider Information

NPI Number	:	1821099243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL KENNETH LALL-TRAIL M.D.

Provider Business Mailing Address
First Line	:	885 KEMPSVILLE RD
Second Line	:	SUITE 101
City	:	NORFOLK
State	:	VA
Zip	:	23502-3800
Country	:	US
Telephone Number	:	757-461-1444
Fax Number	:	757-461-8238

Provider Business Practice Location Address
First Line	:	885 KEMPSVILLE RD STE 101
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-3800
Country	:	US
Telephone Number	:	757-461-1444
Fax Number	:	757-461-8238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/22/2018

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