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General NPI Number Information
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NPI Number | 1457661258
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Entity Type | Organization
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Legal Business Name | 2ND SIGHT OPTICAL INC
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 12300 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23602
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Country | US
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Telephone | 757-249-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 12300 JEFFERSON AVE SUITE 904
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City | NEWPORT NEWS
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State | VA
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Zip | 23602
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Country | US
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Telephone | 757-249-4404
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Fax | 757-249-4761
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DANIELLE NICOLE LONG
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Credential |
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Telephone | 757-766-1988
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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 | 0618001095
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License Number State | VA
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