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General NPI Number Information
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NPI Number | 1659696391
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Entity Type | Organization
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Legal Business Name | JAMES RIVER EYE PHYSICIANS
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 704 THIMBLE SHOALS BLVD SUITE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4544
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Country | US
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Telephone | 757-595-8404
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Fax | 757-595-8353
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Provider Business Mailing Address
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Address Line | 704 THIMBLE SHOALS BLVD SUITE 100
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4544
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Country | US
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Telephone | 757-595-8404
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Fax | 757-595-8353
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Authorized Official
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Title or Position | INSURANCE REPRESENTATIVE
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Name | MS. TRACY L REYNOLDS
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Credential |
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Telephone | 757-595-8404
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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 | 0618000430
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001144
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001735
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101056628
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101041607
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License Number State | VA
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