Healthcare Provider Details

I. General information

NPI: 1629343850
Provider Name (Legal Business Name): GAINESVILLE-HAYMARKET EYECARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 HERITAGE VILLAGE PLZ 110
GAINESVILLE VA
20155-3065
US

IV. Provider business mailing address

7001 HERITAGE VILLAGE PLZ 110
GAINESVILLE VA
20155-3065
US

V. Phone/Fax

Practice location:
  • Phone: 703-999-9279
  • Fax:
Mailing address:
  • Phone: 703-999-9279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000134
License Number StateVA

VIII. Authorized Official

Name: DR. ALLY STOEGER
Title or Position: PRESIDENT
Credential: OD
Phone: 703-999-9279