Healthcare Provider Details

I. General information

NPI: 1548200280
Provider Name (Legal Business Name): CHARLOTTESVILLE EYE ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S PANTOPS DR
CHARLOTTESVILLE VA
22911-8672
US

IV. Provider business mailing address

110 S PANTOPS DR
CHARLOTTESVILLE VA
22911-8672
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-5160
  • Fax: 434-977-5202
Mailing address:
  • Phone: 434-977-5160
  • Fax: 434-977-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101038523
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD W. MORTON
Title or Position: FINANCIAL MANAGER
Credential: M.D.
Phone: 434-977-5160