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General NPI Number Information
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NPI Number | 1225100399
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Entity Type | Organization
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Legal Business Name | ROBERT E TITCOMB OD PC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 1020 INDEPENDENCE BLVD, SUITE 307 HAYGOOD MEDICAL CENTER
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5543
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Country | US
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Telephone | 757-460-3688
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Fax | 757-460-5516
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Provider Business Mailing Address
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Address Line | 1020 INDEPENDENCE BLVD, SUITE 307 HAYGOOD MEDICAL CENTER
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5543
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Country | US
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Telephone | 757-460-3688
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Fax | 757-460-5516
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ROBERT EDWARD TITCOMB
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Credential | OD
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Telephone | 757-460-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 0618000523
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 06180000523
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License Number State | VA
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