Individual
DR. MARY LEE PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
061800738
VA
152WC0802X
Corneal and Contact Management Optometrist
0618000738
VA
152WP0200X
Pediatric Optometrist
0618000738
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
159075
SOUTHERN HEALTH
VA
01
—
466350
ANTHEM BC/BS
VA
01
—
5612691
CIGNA
VA
Enumeration date
09/21/2005
Last updated
02/14/2008
Update your record
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