Healthcare Provider Details

I. General information

NPI: 1639646987
Provider Name (Legal Business Name): INFINITY EYECARE OF DANVILLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 PINEY FOREST RD STE A
DANVILLE VA
24540-4121
US

IV. Provider business mailing address

349 PINEY FOREST RD STE A
DANVILLE VA
24540-4121
US

V. Phone/Fax

Practice location:
  • Phone: 434-425-4025
  • Fax:
Mailing address:
  • Phone: 434-425-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY RICHARD CLARKE
Title or Position: OPTICIAN/OPTICAL MANAGER
Credential: LDO
Phone: 434-425-4025