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General NPI Number Information
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NPI Number | 1659054070
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Entity Type | Organization
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Legal Business Name | OUTREACH EYECARE LLC
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 1020 CARRINGTON PL FL 2
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-1891
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Country | US
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Telephone | 813-534-8203
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 CARRINGTON PL FL 2
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-1891
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BOGDAN GRYNYK
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Credential | OD
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Telephone | 315-383-8617
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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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