Healthcare Provider Details

I. General information

NPI: 1467527770
Provider Name (Legal Business Name): 20-20 EYECARE OF VIRGINIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 MONTICELLO AVE STE 8A
WILLIAMSBURG VA
23188-8230
US

IV. Provider business mailing address

5200 W MERCURY BLVD SUITE 136
NEWPORT NEWS VA
23605-1445
US

V. Phone/Fax

Practice location:
  • Phone: 757-258-1020
  • Fax: 757-229-6280
Mailing address:
  • Phone: 757-827-1223
  • Fax: 757-827-1285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. FORREST R SCHAEFFER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 757-827-1223