Healthcare Provider Details

I. General information

NPI: 1255514345
Provider Name (Legal Business Name): HOMETOWN EYECARE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 S CHURCH ST SUITE 114
SMITHFIELD VA
23430-1862
US

IV. Provider business mailing address

1807 S CHURCH ST SUITE 114
SMITHFIELD VA
23430-1862
US

V. Phone/Fax

Practice location:
  • Phone: 757-365-9090
  • Fax: 757-365-9797
Mailing address:
  • Phone: 757-365-9090
  • Fax: 757-365-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001441
License Number StateVA

VIII. Authorized Official

Name: JAMES DOVER
Title or Position: OWNER/MEMBER
Credential: O.D.
Phone: 757-365-9090