Healthcare Provider Details

I. General information

NPI: 1316020886
Provider Name (Legal Business Name): HARMAN EYE CENTER OF APPOMATTOX AND ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 OLD COURTHOUSE ROAD
APPOMATTOX VA
24522
US

IV. Provider business mailing address

PO BOX 1290
FOREST VA
24551-1290
US

V. Phone/Fax

Practice location:
  • Phone: 434-352-0700
  • Fax: 434-385-1414
Mailing address:
  • Phone: 434-385-5600
  • Fax: 434-455-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001585
License Number StateVA

VIII. Authorized Official

Name: AMY BURTON
Title or Position: INSURANCE MANAGER
Credential:
Phone: 434-385-5600