Healthcare Provider Details

I. General information

NPI: 1053458000
Provider Name (Legal Business Name): ENOCHS EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 BRIDGE RD SUITE 21
SUFFOLK VA
23435-1805
US

IV. Provider business mailing address

3575 BRIDGE RD SUITE 21
SUFFOLK VA
23435-1805
US

V. Phone/Fax

Practice location:
  • Phone: 757-638-2015
  • Fax: 757-638-2010
Mailing address:
  • Phone: 757-638-2015
  • Fax: 757-638-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001031
License Number StateVA

VIII. Authorized Official

Name: DR. STEPHEN MARK ENOCHS
Title or Position: OWNER OPTOMETRIST
Credential: O.D.
Phone: 757-638-2015