Healthcare Provider Details

I. General information

NPI: 1831957307
Provider Name (Legal Business Name): CHARNE ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WESTHAMPTON STA
RICHMOND VA
23226-3330
US

IV. Provider business mailing address

400 WESTHAMPTON STA
RICHMOND VA
23226-3330
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-2020
  • Fax: 804-730-3062
Mailing address:
  • Phone: 804-287-2020
  • Fax: 804-730-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003490
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3889
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: