NPIMap

Organization Active NPI

Lake Ridge Vision Center, Inc

  • Optometrist
  • Woodbridge, VA
National Provider Identifier
1508953431
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
LAKE RIDGE VISION CENTER, INC
Practice address
12444 Dillingham SQ
Woodbridge, VA 22192-5258
Phone
(703) 680-4323
Fax
(703) 680-4358
NPI assigned
Oct 10, 2006
Last updated
Apr 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Dr. Diane Mary Conness, O.D.
Title
General Partner
Phone
(703) 680-4323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

12444 Dillingham SQ
Woodbridge, VA 22192-5258

Mailing address

12444 Dillingham SQ
Woodbridge, VA 22192-5258
Phone (703) 680-4323

National Provider Directory

National Provider Directory

Locations

12444 Dillingham Sq
Woodbridge, VA 22192
Phone (703) 680-4323

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1508953431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12444 DILLINGHAM SQ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925258",
            "telephone_number": "703-680-4323",
            "fax_number": "703-680-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12444 DILLINGHAM SQ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925258",
            "telephone_number": "703-680-4323",
            "fax_number": "703-680-4358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE RIDGE VISION CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "CONNESS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "703-680-4323",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.