Provider Demographics
NPI:1053492702
Name:JULIANA BOCK O.D. P.C.
Entity Type:Organization
Organization Name:JULIANA BOCK O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-744-9132
Mailing Address - Street 1:1118 ALCORN TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4339
Mailing Address - Country:US
Mailing Address - Phone:804-897-8370
Mailing Address - Fax:
Practice Address - Street 1:13546 WATERFORD PL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3928
Practice Address - Country:US
Practice Address - Phone:804-744-9132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10872Medicare PIN
VA410000985Medicare PIN
U60403Medicare UPIN