Wal-Dav Incorporated

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000303 Issued in VA

Legal business name

WAL-DAV INCORPORATED

Practice address

1134 Big Bethel Rd
Hampton, VA 23666-1906

Phone

(757) 827-6612

Fax

(757) 827-6296

NPI assigned

Feb 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lisa G Wallace-Davis, ODNPI 1356373914

Title

Owner

Phone

(757) 827-6612

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Luxur-Eyes Optometric Center Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa G. Wallace-Davis, OD

  • Optometrist
  • Hampton, VA
  • NPI 1356373914
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1170460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323907200000",
    "number": "1962540534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1134 BIG BETHEL RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236661906",
            "telephone_number": "757-827-6612",
            "fax_number": "757-827-6296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134 BIG BETHEL RD",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236661906",
            "telephone_number": "757-827-6612",
            "fax_number": "757-827-6296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAL-DAV INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-03",
        "last_updated": "2011-12-15",
        "status": "A",
        "authorized_official_last_name": "WALLACE-DAVIS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-827-6612",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009232583",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Luxur-Eyes Optometric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shruti Vyas, DPM
• W a Franklin Jr MD PC
• W.J.McCall,Jr.,D.D.S.,P.C.
• Heidi Waddell, DNP
• Lashae Wade-Smith
• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP.
• Walgreen Co
• Walgreen Co

• Optometrist in Hampton, VA
• Providers in Hampton, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.