Healthcare Provider Details

I. General information

NPI: 1306808167
Provider Name (Legal Business Name): RETINA INSTITUTE OF VIRGINIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 STONY POINT PKWY STE 105
RICHMOND VA
23235-1989
US

IV. Provider business mailing address

8720 STONY POINT PKWY STE 105
RICHMOND VA
23235-1989
US

V. Phone/Fax

Practice location:
  • Phone: 804-644-7478
  • Fax: 804-644-8224
Mailing address:
  • Phone: 804-644-7478
  • Fax: 804-644-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLISON LEIGH VEDITZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-644-7478