Healthcare Provider Details

I. General information

NPI: 1881688877
Provider Name (Legal Business Name): JAMES F FORREST OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633D MEDICAL GROUP 77 NEALY AVENUE
JOINT BASE LANGLEY-EUSTIS VA
23665-2040
US

IV. Provider business mailing address

633D MDG 77 NEALY AVE
JOINT BASE LANGLEY-EUSTIS VA
23665-2040
US

V. Phone/Fax

Practice location:
  • Phone: 757-764-6973
  • Fax:
Mailing address:
  • Phone: 757-764-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02636
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: