Healthcare Provider Details

I. General information

NPI: 1467623553
Provider Name (Legal Business Name): RICHMOND EYE & EAR HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 STONY POINT PKWY STE 100
RICHMOND VA
23235-1968
US

IV. Provider business mailing address

8700 STONY POINT PKWY STE 240
RICHMOND VA
23235-1966
US

V. Phone/Fax

Practice location:
  • Phone: 804-545-9435
  • Fax: 804-545-9440
Mailing address:
  • Phone: 804-775-4500
  • Fax: 804-545-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number0618000920
License Number StateVA

VIII. Authorized Official

Name: MR. BRUCE KUPPER
Title or Position: CEO
Credential:
Phone: 804-775-4500