Healthcare Provider Details

I. General information

NPI: 1295962710
Provider Name (Legal Business Name): DIMITRIOS N SISMANIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
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: 804-934-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101258198
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number0101258198
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: