Nancy Jean Petrilak, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9998 Issued in CA

Practice address

1St Medical Group
77 Nealy Ave
Langley Afb, VA 23665-2023

Phone

(757) 764-6973

NPI assigned

Apr 10, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508089673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CARNOUSTIE CT",
            "city": "YORKTOWN",
            "state": "VA",
            "postal_code": "236935517",
            "telephone_number": "757-969-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1ST MEDICAL GROUP",
            "address_2": "77 NEALY AVE",
            "city": "LANGLEY AFB",
            "state": "VA",
            "postal_code": "236652023",
            "telephone_number": "757-764-6973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILAK",
        "first_name": "NANCY",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Christopher Noah Jr.
• Jennifer Nanda Nwokocha
• Tania M Parise, PT
• Bryan George Paul
• Holly L. Peck, LCSW
• Heather Elise Prather, DDS
• Deandra Michele Price, DDS
• Wayne Martin Pritt, M.D.
• Mavis Gaskins Rowe, LCSW
• Kristopher Carson Rusinko, PHARMD

• Optometrist in Langley Afb, VA
• Providers in Langley Afb, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.