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General NPI Number Information
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NPI Number | 1639646987
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Entity Type | Organization
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Legal Business Name | INFINITY EYECARE OF DANVILLE INC.
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 349 PINEY FOREST RD STE A
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City | DANVILLE
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State | VA
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Zip | 24540-4121
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Country | US
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Telephone | 434-425-4025
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Fax |
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Provider Business Mailing Address
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Address Line | 349 PINEY FOREST RD STE A
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City | DANVILLE
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State | VA
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Zip | 24540-4121
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Country | US
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Telephone | 434-425-4025
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Fax |
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Authorized Official
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Title or Position | OPTICIAN/OPTICAL MANAGER
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Name | MR. JEFFREY RICHARD CLARKE
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Credential | LDO
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Telephone | 434-425-4025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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