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General NPI Number Information
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NPI Number | 1649708314
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Entity Type | Individual
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Provider Name | KEVIN RAYMOND ADER JR. OD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 11/22/2020
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Provider Practice Location Address
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Address Line | 1912 GRAVES MILL RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-4237
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Country | US
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Telephone | 434-385-7898
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Fax |
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Provider Business Mailing Address
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Address Line | 111 RED MAPLE CT
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City | LYNCHBURG
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State | VA
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Zip | 24501
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Country | US
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Telephone | 443-834-5177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0618002564
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License Number State | VA
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