Healthcare Provider Details

I. General information

NPI: 1518190677
Provider Name (Legal Business Name): ALICE CIOARA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 E RIO RD
CHARLOTTESVILLE VA
22901-1405
US

IV. Provider business mailing address

107 COMMUNITY WAY APT 333
STAUNTON VA
24401-4983
US

V. Phone/Fax

Practice location:
  • Phone: 434-973-7996
  • Fax: 434-973-7992
Mailing address:
  • Phone: 954-864-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1758DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4434
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001900
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: