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General NPI Number Information
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NPI Number | 1710420856
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Entity Type | Organization
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Legal Business Name | PENINSULA EYE CARE, LLC
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 1215 GEORGE WASHINGTON MEM HWY STE V
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City | YORKTOWN
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State | VA
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Zip | 23693-4316
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Country | US
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Telephone | 757-978-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 307 MAXWELL LN
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1511
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Country | US
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Telephone | 757-814-0827
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR/SOLE MANAGER
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Name | DR. DAVID BUCK
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Credential | O.D.
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Telephone | 757-814-0827
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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 | 0618002155
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License Number State | VA
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