Healthcare Provider Details

I. General information

NPI: 1487053989
Provider Name (Legal Business Name): ADAM GARCIA-MANFREDI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-1373
US

IV. Provider business mailing address

576 JEFFERSON AVE
FORT EUSTIS VA
23604-1373
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7620
  • Fax: 757-314-7913
Mailing address:
  • Phone: 757-314-7620
  • Fax: 757-314-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618003304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: