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General NPI Number Information
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NPI Number | 1720179104
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Entity Type | Organization
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Legal Business Name | THE EYE SPECIALISTS LTD
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 813 INDEPENDENCE BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6004
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Country | US
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Telephone | 757-490-9091
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Fax | 757-490-3250
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Provider Business Mailing Address
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Address Line | 813 INDEPENDENCE BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6004
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Country | US
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Telephone | 757-490-9091
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Fax | 757-490-3250
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIETRICH ALBERT FELLNER
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Credential | M.D.
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Telephone | 757-490-9091
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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 | 0618000757
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101232452
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License Number State | VA
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