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General NPI Number Information
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NPI Number | 1770801326
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE EYECARE OF VIRGINIA
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 1660 TAPPAHANNOCK BLVD
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City | TAPPAHANNOCK
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State | VA
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Zip | 22560-9320
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Country | US
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Telephone | 804-443-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 516 KERRI COVE WAY 203
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-6820
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Country | US
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Telephone | 965-326-0436
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. CHARLINE M ANSELME
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Credential | O.D.
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Telephone | 954-326-0436
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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 | 0618001823
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License Number State | VA
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