=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093716037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATARACT AND REFRACTIVE SURGERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2005
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2010 BREMO ROAD SUITE 132
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-285-0680
-----------------------------------------------------
Fax | 804-282-6365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2010 BREMO RD #132
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23226-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-285-0680
-----------------------------------------------------
Fax | 804-282-6365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RCM MANAGER
-----------------------------------------------------
Name | MRS. AMY BURTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-661-7762
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | OH 651
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------