Healthcare Provider Details

I. General information

NPI: 1689672685
Provider Name (Legal Business Name): MARK JOHN MORRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 02/07/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEMORIAL DR STE A
DANVILLE VA
24541-1680
US

IV. Provider business mailing address

2010 BREMO RD STE 128A
RICHMOND VA
23226-2444
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-3232
  • Fax:
Mailing address:
  • Phone: 877-969-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101046318
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: