MEDICARE: EPPERSON EYE,P.C.

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
1	152W00000X	Optometrist	0618000780	VA

General Provider Information

NPI Number	:	1306057021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPPERSON EYE,P.C.

Provider Business Mailing Address
First Line	:	11369 NUCKOLS RD
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5504
Country	:	US
Telephone Number	:	804-864-2020
Fax Number	:	804-377-8803

Provider Business Practice Location Address
First Line	:	11369 NUCKOLS RD
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5504
Country	:	US
Telephone Number	:	804-864-2020
Fax Number	:	804-377-8803

Authorized Official
Title or Position	:	OWNERPRES.
Name	:	DR. KENNETH ROBERT EPPERSON
Credential	:	O.D.
Telephone Number	:	804-864-2020

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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