Provider Demographics
NPI:1144438144
Name:LEGRAND, DAVID G (BCO)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:LEGRAND
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 POPLAR HILL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5518
Mailing Address - Country:US
Mailing Address - Phone:757-484-4900
Mailing Address - Fax:215-496-1307
Practice Address - Street 1:3800 POPLAR HILL RD
Practice Address - Street 2:SUITE E
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5518
Practice Address - Country:US
Practice Address - Phone:757-484-4900
Practice Address - Fax:757-673-4722
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA196810OtherANTHEM HEALTH KEEPERS/BC