Provider Demographics
NPI:1083798391
Name:WALDRON, LAUREEN GODDARD (OD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREEN
Middle Name:GODDARD
Last Name:WALDRON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6653
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5227
Mailing Address - Country:US
Mailing Address - Phone:757-253-7901
Mailing Address - Fax:757-253-7928
Practice Address - Street 1:4630 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8200
Practice Address - Country:US
Practice Address - Phone:757-253-7901
Practice Address - Fax:757-253-7928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist