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General NPI Number Information
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NPI Number | 1497935829
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Entity Type | Organization
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Legal Business Name | CRATER VISION INC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 07/06/2017
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Provider Practice Location Address
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Address Line | 3333 S CRATER RD STE 2D
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City | PETERSBURG
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State | VA
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Zip | 23805-9276
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Country | US
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Telephone | 804-732-3937
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Fax | 807-733-6005
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Provider Business Mailing Address
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Address Line | 3333 S CRATER RD STE 2D
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City | PETERSBURG
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State | VA
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Zip | 23805-9276
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Country | US
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Telephone | 804-732-3937
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Fax | 807-733-6005
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK E MOORE
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Credential |
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Telephone | 804-732-3937
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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 |
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License Number State |
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