Provider Demographics
NPI:1598985681
Name:KERALAJOLISA
Entity Type:Organization
Organization Name:KERALAJOLISA
Other - Org Name:STERLING OPTICAL #680
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:340-773-8880
Mailing Address - Street 1:3000 GOLDEN ROCK SHOPPING CENTER
Mailing Address - Street 2:SUITE 14 STERLING OPTICAL
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-773-8880
Mailing Address - Fax:340-773-8433
Practice Address - Street 1:3000 GOLDEN ROCK SHOPPING CENTER
Practice Address - Street 2:SUITE 14 STERLING OPTICAL
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-773-8880
Practice Address - Fax:340-773-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI20152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty