Provider Demographics
NPI:1821099243
Name:LALL-TRAIL, JOEL KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:KENNETH
Last Name:LALL-TRAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-461-1444
Mailing Address - Fax:757-461-8238
Practice Address - Street 1:885 KEMPSVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-461-1444
Practice Address - Fax:757-461-8238
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227716207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0800727OtherUNITED HEALTH CARE PROV
NC89063YKOtherNC MEDICAID
VA216425OtherANTHEM PROV #
VA541299712OtherSUPERIOR VISION PROV #
VA600215467OtherCIGNA
VA6308289Medicaid
VA216425OtherHEALTHKEEPERS PROV #
VA541299712OtherPHCS PROVIDER #
VA28935OtherOPTIMA PROV #
VA541299712OtherFIRST HEALTH PROV #
VA6301100OtherVA PREMIER PROV #
VA180040530OtherRAILROAD MEDICARE
VA541299712OtherVA HEALTH NETWORK
VA7013145OtherAETNA PROV #
VA180040530OtherRAILROAD MEDICARE
VA28935OtherOPTIMA PROV #