Provider Demographics
NPI:1700142114
Name:LAKE RIDGE OPHTHALMOLOGY LLC
Entity Type:Organization
Organization Name:LAKE RIDGE OPHTHALMOLOGY LLC
Other - Org Name:NORMA L ZAPATA DE PEREZ MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:LIZETTE
Authorized Official - Last Name:ZAPATA DE PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-494-1388
Mailing Address - Street 1:1920 OPITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3304
Mailing Address - Country:US
Mailing Address - Phone:703-494-1388
Mailing Address - Fax:703-494-1113
Practice Address - Street 1:1920 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3304
Practice Address - Country:US
Practice Address - Phone:703-494-1388
Practice Address - Fax:703-494-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230473207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty