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General NPI Number Information
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NPI Number | 1306933536
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Entity Type | Organization
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Legal Business Name | AFTEL & RADER, OPTOMETRISTS, P.L.C.
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 5913 PORTSMOUTH BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-1445
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Country | US
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Telephone | 757-488-0192
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Fax | 757-488-4567
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Provider Business Mailing Address
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Address Line | 5913 PORTSMOUTH BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-1445
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Country | US
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Telephone | 757-488-0192
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Fax | 757-488-4567
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE THOMAS RADER
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Credential | O.D.
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Telephone | 757-488-0192
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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 | 0618000333
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License Number State | VA
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