Healthcare Provider Details

I. General information

NPI: 1295882835
Provider Name (Legal Business Name): COLONIAL OPTHALMOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 MONTICELLO AVE
WILLIAMSBURG VA
23188-8213
US

IV. Provider business mailing address

5215 MONTICELLO AVE
WILLIAMSBURG VA
23188-8213
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-4000
  • Fax:
Mailing address:
  • Phone: 757-229-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GLENN C CAMPBELL
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 757-229-4000