Healthcare Provider Details

I. General information

NPI: 1306863337
Provider Name (Legal Business Name): SUFFOLK EYE PHYSICIANS AND SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 MEADE PKWY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

2016 MEADE PKWY
SUFFOLK VA
23434-4259
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-1533
  • Fax: 757-539-6591
Mailing address:
  • Phone: 757-539-1533
  • Fax: 757-539-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101021632
License Number StateVA

VIII. Authorized Official

Name: MRS. DEBORAH C. KEMPTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-539-1533