Healthcare Provider Details

I. General information

NPI: 1043448640
Provider Name (Legal Business Name): VALERIE FOYTIK OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 EDWIN DR
VIRGINIA BEACH VA
23462-4522
US

IV. Provider business mailing address

345 EDWIN DR
VIRGINIA BEACH VA
23462-4522
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-5555
  • Fax: 757-499-2636
Mailing address:
  • Phone: 757-497-5555
  • Fax: 757-499-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001847
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: