Organization
GLAUCOMA LASER CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAWNIELLE J KERNER MD (PRESIDENT)
(757) 440-1144
Entity
Organization
Contact information
Practice address
160 KINGSLEY LN, STE 300, NORFOLK, VA 23505-4600
(757) 440-1144
(757) 440-1117
Mailing address
160 KINGSLEY LN, STE 300, NORFOLK, VA 23505-4600
(757) 440-1144
(757) 440-1117
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
Primary
0101052595
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006304869
—
VA
01
—
242315
ANTHEM
VA
Enumeration date
06/27/2005
Last updated
07/21/2022
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