Healthcare Provider Details

I. General information

NPI: 1114784246
Provider Name (Legal Business Name): EYE CARE CENTER OF VIRGINIA SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 EMERYWOOD PKWY STE 103
HENRICO VA
23294-3746
US

IV. Provider business mailing address

2924 EMERYWOOD PKWY STE 103
HENRICO VA
23294-3746
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-9303
  • Fax:
Mailing address:
  • Phone: 804-330-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARTH STEVENS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 804-330-9303