Provider Demographics
NPI:1144318841
Name:WALTER, LILIAN V (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:V
Last Name:WALTER
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 QUAINT DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4591
Mailing Address - Country:US
Mailing Address - Phone:703-583-9611
Mailing Address - Fax:703-580-6945
Practice Address - Street 1:5073 WATERWAY DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1259
Practice Address - Country:US
Practice Address - Phone:703-580-7274
Practice Address - Fax:703-580-6945
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002209156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician