Healthcare Provider Details

I. General information

NPI: 1376722249
Provider Name (Legal Business Name): EYE ASSOCIATES OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD SUITE 209
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

5875 BREMO RD SUITE 209
RICHMOND VA
23226-1934
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-7533
  • Fax: 804-285-8773
Mailing address:
  • Phone: 804-285-7533
  • Fax: 804-285-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number0101035231
License Number StateVA

VIII. Authorized Official

Name: MR. MATT GASKIN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 804-285-7533