Healthcare Provider Details

I. General information

NPI: 1508048026
Provider Name (Legal Business Name): BORTNICK & FURMAN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23079 COURTHOUSE AVE
ACCOMAC VA
23301-1505
US

IV. Provider business mailing address

23079 COURTHOUSE AVE
ACCOMAC VA
23301-1505
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-7040
  • Fax: 757-787-2886
Mailing address:
  • Phone: 757-787-7040
  • Fax: 757-787-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK WAYNE KEYES
Title or Position: OPTOMETRIST/PARTNER
Credential: O.D.
Phone: 757-787-7040