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General NPI Number Information
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NPI Number | 1487918132
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Entity Type | Organization
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Legal Business Name | JAMES RIVER EYE ASSOCIATES
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 5617 W BROAD ST
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City | RICHMOND
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State | VA
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Zip | 23230-2614
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Country | US
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Telephone | 804-282-7228
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Fax | 804-285-3781
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Provider Business Mailing Address
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Address Line | 5617 W BROAD ST
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City | RICHMOND
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State | VA
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Zip | 23230-2614
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Country | US
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Telephone | 508-837-3790
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Fax | 804-285-3781
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT G. RAINER
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Credential | OD
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Telephone | 508-837-3790
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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 | 0618000110
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License Number State | VA
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