Healthcare Provider Details

I. General information

NPI: 1821462680
Provider Name (Legal Business Name): EDINBURGH EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 CARMICHAEL WAY SUITE 318
CHESAPEAKE VA
23322-2185
US

IV. Provider business mailing address

236 CARMICHAEL WAY SUITE 318
CHESAPEAKE VA
23322-2185
US

V. Phone/Fax

Practice location:
  • Phone: 757-368-3937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001467
License Number StateVA

VIII. Authorized Official

Name: DR. RAHIM KANJI
Title or Position: MEMBER
Credential: OD
Phone: 407-342-7273