Healthcare Provider Details

I. General information

NPI: 1558508952
Provider Name (Legal Business Name): DR. PHILIP LARRABEE AND ASSOCIATES OPTOMETRISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 CHATTANOOGA PLZ
MIDLOTHIAN VA
23112-4865
US

IV. Provider business mailing address

4617 LEONARD PKWY
RICHMOND VA
23226
US

V. Phone/Fax

Practice location:
  • Phone: 804-744-7327
  • Fax: 804-744-7328
Mailing address:
  • Phone: 804-359-1035
  • Fax: 804-359-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000324
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0618000324
License Number StateVA

VIII. Authorized Official

Name: DR. PHILIP LARRABEE
Title or Position: OPTOMETRIST/PRESIDENT
Credential: O.D.
Phone: 757-880-3320