Healthcare Provider Details

I. General information

NPI: 1518047554
Provider Name (Legal Business Name): BRIAN L TOWNSEND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7074 MECHANICSVILLE TPKE
MECHANICSVILLE VA
23111-3629
US

IV. Provider business mailing address

7074 MECHANICSVILLE TPKE
MECHANICSVILLE VA
23111-3629
US

V. Phone/Fax

Practice location:
  • Phone: 804-746-5245
  • Fax:
Mailing address:
  • Phone: 804-746-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000524
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: