Healthcare Provider Details

I. General information

NPI: 1427058387
Provider Name (Legal Business Name): CHARLOTTESVILLE EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
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: 434-977-6697
  • Fax: 434-977-6714
Mailing address:
  • Phone: 434-977-6697
  • Fax: 434-977-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARK A. GONCE
Title or Position: SECRETARY
Credential: MD
Phone: 434-977-5160