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General NPI Number Information
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NPI Number | 1750456745
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Entity Type | Organization
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Legal Business Name | ALBEMARLE PEDIATRIC OPHTHALMOLOGY & STRABISMUS PC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 1101 EAST JEFFERSON STREET SUITE 3
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5353
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Country | US
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Telephone | 434-295-5193
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Fax | 434-977-0714
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Provider Business Mailing Address
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Address Line | 1101 EAST JEFFERSON STREET SUITE 3
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5353
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Country | US
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Telephone | 434-295-5193
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Fax | 434-977-0714
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. GALE KINNIER MARTIN
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Credential |
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Telephone | 434-295-5193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101239819
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License Number State | VA
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