Healthcare Provider Details

I. General information

NPI: 1407913395
Provider Name (Legal Business Name): VIRGINIA OCULOFACIAL SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WILKES RIDGE DR STE 100
RICHMOND VA
23233-7963
US

IV. Provider business mailing address

1300 WILKES RIDGE DR STE 100
RICHMOND VA
23233-7963
US

V. Phone/Fax

Practice location:
  • Phone: 804-934-9344
  • Fax: 804-934-9034
Mailing address:
  • Phone: 804-934-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101046909
License Number StateVA

VIII. Authorized Official

Name: DIMITRIOS N SISMANIS
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 804-934-9344