Healthcare Provider Details

I. General information

NPI: 1366771024
Provider Name (Legal Business Name): JOY C TOMKO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 ACADEMY AVE STE 200
PORTSMOUTH VA
23703
US

IV. Provider business mailing address

3235 ACADEMY AVE STE 200
PORTSMOUTH VA
23703-3200
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-0400
  • Fax: 757-686-0947
Mailing address:
  • Phone: 757-483-0400
  • Fax: 757-686-0947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001909
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: