Provider Demographics
NPI:1225155229
Name:PAUL LALLANDE, OD, PC, DOCTOR OF OPTOMETRY
Entity Type:Organization
Organization Name:PAUL LALLANDE, OD, PC, DOCTOR OF OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CLERC
Authorized Official - Last Name:LALLANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-963-0808
Mailing Address - Street 1:125 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2434
Mailing Address - Country:US
Mailing Address - Phone:276-963-0808
Mailing Address - Fax:276-963-7538
Practice Address - Street 1:125 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2434
Practice Address - Country:US
Practice Address - Phone:276-963-0808
Practice Address - Fax:276-963-7538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009203567Medicaid
VA021335OtherANTHEM BLUE CROSS
VA0192560001Medicare NSC
T21898Medicare UPIN
VAC10498Medicare PIN