Healthcare Provider Details

I. General information

NPI: 1821241746
Provider Name (Legal Business Name): PREVENTIVE FOOT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W LEIGH ST STE 105-A
RICHMOND VA
23220-3200
US

IV. Provider business mailing address

2831 ROBYS WAY
MIDLOTHIAN VA
23113-1428
US

V. Phone/Fax

Practice location:
  • Phone: 804-643-8863
  • Fax: 804-643-2272
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103000873
License Number StateVA

VIII. Authorized Official

Name: DR. FRANKLIN OGNELODH
Title or Position: PRESIDENT
Credential: DPM
Phone: 804-643-8863