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General NPI Number Information
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NPI Number | 1063845816
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Entity Type | Organization
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Legal Business Name | EASTERN VIRGINIA EYE INSTITUTE
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 2147 OLD GREENBRIER RD
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2635
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Country | US
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Telephone | 757-354-2258
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Fax |
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Provider Business Mailing Address
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Address Line | 2147 OLD GREENBRIER RD
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2635
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. SANDEEP S SAMUDRE
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Credential | PHD, MPH
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Telephone | 757-354-2258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number |
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License Number State |
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