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NPI Code Detail

MEDICARE: ROBERT M. FORNILI OD

MEDICARE: ROBERT M. FORNILI OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0601001043VA

General Provider Information

NPI Number : 1003952763
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT M. FORNILI OD
Provider Business Mailing Address
First Line : 9392 HARTFORD OAKS CIR
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23116-6525
Country : US
Telephone Number : 804-730-9392
Fax Number :
Provider Business Practice Location Address
First Line : 7430 BELL CREEK RD
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23111-3550
Country : US
Telephone Number : 804-559-6080
Fax Number : 804-559-6081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 07/08/2007

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