Provider Demographics
NPI:1730703463
Name:PALESIS, ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:PALESIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 W BROAD ST STE 1324
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7912
Mailing Address - Country:US
Mailing Address - Phone:888-492-7297
Mailing Address - Fax:
Practice Address - Street 1:11800 W BROAD ST STE 1324
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7912
Practice Address - Country:US
Practice Address - Phone:888-492-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist