Provider Demographics
NPI:1770275257
Name:EMERSON, GAIL (FL LDO, VA LDO)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:
Last Name:EMERSON
Suffix:
Gender:
Credentials:FL LDO, VA LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 WORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4121
Mailing Address - Country:US
Mailing Address - Phone:703-491-0523
Mailing Address - Fax:703-491-0531
Practice Address - Street 1:14000 WORTH AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4121
Practice Address - Country:US
Practice Address - Phone:703-491-0523
Practice Address - Fax:703-491-0531
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6490156FX1800X
VA1101004652156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician