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General NPI Number Information
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NPI Number | 1225560394
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Entity Type | Organization
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Legal Business Name | SPRING CREEK EYECARE LLC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 34 JEFFERSON CT SUITE B
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City | ZION CROSSROADS
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State | VA
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Zip | 22942-9602
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Country | US
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Telephone | 434-260-0220
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Fax | 844-526-2650
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Provider Business Mailing Address
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Address Line | 34 JEFFERSON CT SUITE B
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City | ZION CROSSROADS
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State | VA
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Zip | 22942-9602
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Country | US
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Telephone | 434-260-0220
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Fax | 844-526-2650
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Authorized Official
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Title or Position | OWNER
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Name | JAIME RENAE EASTON
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Credential | O.D.
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Telephone | 434-260-0200
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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 | 0618001497
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License Number State | VA
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