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General NPI Number Information
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NPI Number | 1003952763
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Entity Type | Individual
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Provider Name | ROBERT M. FORNILI OD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7430 BELL CREEK RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-3550
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Country | US
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Telephone | 804-559-6080
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Fax | 804-559-6081
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Provider Business Mailing Address
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Address Line | 9392 HARTFORD OAKS CIR
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-6525
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Country | US
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Telephone | 804-730-9392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601001043
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License Number State | VA
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