Healthcare Provider Details

I. General information

NPI: 1669480448
Provider Name (Legal Business Name): EYE SURGEONS OF RICHMOND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 01/18/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WESTHAMPTON STA
RICHMOND VA
23226-3330
US

IV. Provider business mailing address

400 WESTHAMPTON STA
RICHMOND VA
23226-3330
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-4200
  • Fax:
Mailing address:
  • Phone: 804-287-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC MILLER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 804-287-4266