Organization
LAKE RIDGE VISION CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE MARY CONNESS O.D. (GENERAL PARTNER)
(703) 680-4323
Entity
Organization
Contact information
Practice address
12444 DILLINGHAM SQ, WOODBRIDGE, VA 22192-5258
(703) 680-4323
(703) 680-4358
Mailing address
12444 DILLINGHAM SQ, WOODBRIDGE, VA 22192-5258
(703) 680-4323
(703) 680-4358
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
10/10/2006
Last updated
04/22/2008
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