Provider Demographics
NPI:1922642149
Name:WILLIS, JOYCE LORRAINE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:LORRAINE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2324
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23327-2324
Mailing Address - Country:US
Mailing Address - Phone:757-282-8166
Mailing Address - Fax:
Practice Address - Street 1:167 TUSCANNY VLY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-5711
Practice Address - Country:US
Practice Address - Phone:843-271-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist