Provider Demographics
NPI:1467217257
Name:SOUDER, ANNE GARAB (LDO)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:GARAB
Last Name:SOUDER
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 STONERIDGE DR N
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3088
Mailing Address - Country:US
Mailing Address - Phone:434-990-0273
Mailing Address - Fax:434-990-0945
Practice Address - Street 1:135 STONERIDGE DR N
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3088
Practice Address - Country:US
Practice Address - Phone:434-990-0273
Practice Address - Fax:434-990-0945
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001749156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician