Organization
MID ATLANTIC OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE WALLER (PRACTICE MANAGER)
(757) 547-9830
Entity
Organization
Contact information
Practice address
6161 KEMPSVILLE CIR, STE. 130, NORFOLK, VA 23502-3932
(757) 455-5130
(757) 466-7616
Mailing address
109 WIMBLEDON SQ, STE.E, CHESAPEAKE, VA 23320-4945
(757) 547-9830
(757) 548-0721
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001314
VA
Other
Enumeration date
12/31/2015
Last updated
12/31/2015
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