Healthcare Provider Details

I. General information

NPI: 1124238050
Provider Name (Legal Business Name): OMG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 OLD GEORGE WASHINGTON HWY N #Q
CHESAPEAKE VA
23323-2209
US

IV. Provider business mailing address

PO BOX 6855
CHESAPEAKE VA
23323-0855
US

V. Phone/Fax

Practice location:
  • Phone: 757-635-2625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code156FX1201X
TaxonomyOptometric Assistant Technician
License Number
License Number State

VIII. Authorized Official

Name: D E
Title or Position: MEMBER
Credential:
Phone: 757-635-2625