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General NPI Number Information
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NPI Number | 1114784246
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Entity Type | Organization
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Legal Business Name | EYE CARE CENTER OF VIRGINIA SURGICAL SERVICES LLC
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 2924 EMERYWOOD PKWY STE 103
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City | HENRICO
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State | VA
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Zip | 23294-3746
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Country | US
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Telephone | 804-330-9303
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Fax |
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Provider Business Mailing Address
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Address Line | 2924 EMERYWOOD PKWY STE 103
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City | HENRICO
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State | VA
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Zip | 23294-3746
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Country | US
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Telephone | 804-330-9303
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GARTH STEVENS
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Credential | MD
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Telephone | 804-330-9303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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