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General NPI Number Information
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NPI Number | 1013066240
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Entity Type | Individual
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Provider Name | GREGG ALAN BALDWIN OD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11500 MIDLOTHIAN TURNPIKE SUITE #716B
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City | RICHMOND
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State | VA
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Zip | 23235
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Country | US
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Telephone | 804-897-5542
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 CREEKSIDE DRIVE
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902
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Country | US
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Telephone | 434-971-4722
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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 | 0618000664
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License Number State | VA
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