Provider Demographics
NPI:1972294916
Name:COVINGTON, LAURIE WOMACK
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:WOMACK
Last Name:COVINGTON
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 1:1800 PEERY DR
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2377
Mailing Address - Country:US
Mailing Address - Phone:434-392-1669
Mailing Address - Fax:434-392-6454
Practice Address - Street 1:1800 PEERY DR
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2377
Practice Address - Country:US
Practice Address - Phone:434-392-1669
Practice Address - Fax:434-392-6154
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002810156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician