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General NPI Number Information
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NPI Number | 1659483022
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Entity Type | Organization
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Legal Business Name | HAMPTON ROADS RETINA CENTER
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 516 INNOVATION DR SUITE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3866
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Country | US
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Telephone | 757-436-0011
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Fax | 757-436-0075
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Provider Business Mailing Address
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Address Line | 516 INNOVATION DR SUITE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3866
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Country | US
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Telephone | 757-436-0011
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Fax | 757-436-0075
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON M ADLEBERG
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Credential | M.D.
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Telephone | 757-436-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101056722
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License Number State | VA
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