Provider Demographics
NPI:1679663850
Name:BOCK, JULIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:
Last Name:BOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000341152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
U60403Medicare UPIN
410000985Medicare ID - Type Unspecified
VA00Y158J01Medicare PIN