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General NPI Number Information
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NPI Number | 1467766279
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Entity Type | Organization
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Legal Business Name | COLONIAL EYE CARE, PLC
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 5121 CENTER ST SUITE 102
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2686
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Country | US
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Telephone | 757-903-2633
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Fax | 757-903-2634
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Provider Business Mailing Address
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Address Line | 5121 CENTER ST SUITE 102
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2686
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Country | US
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Telephone | 757-903-2633
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Fax | 757-903-2634
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT L SEGELEON
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Credential | OD
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Telephone | 757-903-2633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 0618001521
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 0615001521
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 0618001521
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 0618001521
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001521
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License Number State | VA
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