Healthcare Provider Details

I. General information

NPI: 1306379003
Provider Name (Legal Business Name): PROVISION EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10212 STAPLES MILL RD
GLEN ALLEN VA
23060-3064
US

IV. Provider business mailing address

10212 STAPLES MILL RD
GLEN ALLEN VA
23060-3064
US

V. Phone/Fax

Practice location:
  • Phone: 804-756-2020
  • Fax: 804-447-6885
Mailing address:
  • Phone: 804-756-2020
  • Fax: 804-447-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001394
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618001394
License Number StateVA

VIII. Authorized Official

Name: ADAM MELTON
Title or Position: PRESIDENT
Credential:
Phone: 804-756-2020