Healthcare Provider Details

I. General information

NPI: 1841275831
Provider Name (Legal Business Name): JOHN R. NORDLUND M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 MONTICELLO AVE STE A
WILLIAMSBURG VA
23188-8232
US

IV. Provider business mailing address

2010 BREMO RD STE 128A
RICHMOND VA
23226-2444
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-4000
  • Fax:
Mailing address:
  • Phone: 757-229-4000
  • Fax: 757-220-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101048352
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: