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General NPI Number Information
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NPI Number | 1659469567
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Entity Type | Organization
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Legal Business Name | FARMVILLE VISION CENTER INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | COLLEGE PLAZA SHOPPING CENTER
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-392-8408
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Fax | 434-392-8408
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Provider Business Mailing Address
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Address Line | COLLEGE PLAZA SHOPPING CENTER
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-392-8408
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Fax | 434-392-8408
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Authorized Official
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Title or Position | OWNER
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Name | MS. CATHERINE E FOURQUREAN
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Credential | OPTCIAN
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Telephone | 434-392-8408
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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 | 1101 002474
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License Number State | VA
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