Provider Demographics
NPI:1891945697
Name:RIVELLINO, LAUREN P (OD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:P
Last Name:RIVELLINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 N MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2344
Mailing Address - Country:US
Mailing Address - Phone:540-213-7720
Mailing Address - Fax:540-213-7729
Practice Address - Street 1:1500 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9032
Practice Address - Country:US
Practice Address - Phone:540-213-7720
Practice Address - Fax:540-213-9441
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist