Healthcare Provider Details

I. General information

NPI: 1205852597
Provider Name (Legal Business Name): EYE DOCTORS OF RICHMOND, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 IRON BRIDGE RD SUITE 200
CHESTER VA
23831-1466
US

IV. Provider business mailing address

400 WESTHAMPTON STA
RICHMOND VA
23226-3330
US

V. Phone/Fax

Practice location:
  • Phone: 804-340-5733
  • Fax:
Mailing address:
  • Phone: 804-287-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDDIE CLARK
Title or Position: CFO
Credential:
Phone: 804-287-4200