Healthcare Provider Details

I. General information

NPI: 1962578823
Provider Name (Legal Business Name): ROBERT E TITCOMB OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MASON AVE
CAPE CHARLES VA
23310-3201
US

IV. Provider business mailing address

217 MASON AVE
CAPE CHARLES VA
23310-3201
US

V. Phone/Fax

Practice location:
  • Phone: 757-331-2020
  • Fax: 757-331-4077
Mailing address:
  • Phone: 757-331-2020
  • Fax: 757-331-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000523
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618000523
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number0618000523
License Number StateVA

VIII. Authorized Official

Name: DR. ROBERT EDWARD TITCOMB
Title or Position: OPTOMETRIST OWNER
Credential: OD
Phone: 757-331-2020