Provider Demographics
NPI:1871713016
Name:KERALA JOLISA
Entity type:Organization
Organization Name:KERALA JOLISA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:340-773-8880
Mailing Address - Street 1:STERLING OPTICAL 9000 LOCKHART GARDENS
Mailing Address - Street 2:3 ESTATE THOMAS
Mailing Address - City:CHARLOTTE AMALIE
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:340-774-8500
Mailing Address - Fax:340-774-3704
Practice Address - Street 1:STERLING OPTICAL 9000 LOCKHART GARDENS
Practice Address - Street 2:3 ESTATE THOMAS
Practice Address - City:CHARLOTTE AMALIE
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-8500
Practice Address - Fax:340-774-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI20152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty