Healthcare Provider Details

I. General information

NPI: 1295787539
Provider Name (Legal Business Name): OCULOPLASTICS AND ORBITAL CONSULTANTS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PETER JEFFERSON PKWY SUITE 140
CHARLOTTESVILLE VA
22911-8605
US

IV. Provider business mailing address

630 PETER JEFFERSON PKWY SUITE 140
CHARLOTTESVILLE VA
22911-8605
US

V. Phone/Fax

Practice location:
  • Phone: 434-244-8610
  • Fax: 434-244-8611
Mailing address:
  • Phone: 434-244-8610
  • Fax: 434-244-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARA A KALTREIDER
Title or Position: OWNER
Credential: MD
Phone: 434-244-8610