Provider Demographics
NPI:1134961964
Name:BANKS, SANTANA MARIA (LDO)
Entity type:Individual
Prefix:MISS
First Name:SANTANA
Middle Name:MARIA
Last Name:BANKS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-2751
Mailing Address - Country:US
Mailing Address - Phone:434-409-4606
Mailing Address - Fax:
Practice Address - Street 1:223 E PIEDMONT ST
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2751
Practice Address - Country:US
Practice Address - Phone:434-409-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004443156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty