Healthcare Provider Details

I. General information

NPI: 1124396981
Provider Name (Legal Business Name): EYE SURGEONS OF RICHMOND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 WATKINS CENTRE PKWY SUITE 100
MIDLOTHIAN VA
23114-4404
US

IV. Provider business mailing address

400 WESTHAMPTON STA
RICHMOND VA
23226-3330
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7420
  • Fax: 804-287-4210
Mailing address:
  • Phone: 804-287-4200
  • Fax: 804-287-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. EDDIE F CLARK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 804-287-4236