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General NPI Number Information
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NPI Number | 1790098325
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC SERVICES
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Dates
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Enumeration Date | 07/25/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 792 OLD CUTLER RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-6050
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Country | US
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Telephone | 757-705-3082
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Fax | 757-340-0891
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Provider Business Mailing Address
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Address Line | 792 OLD CUTLER RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-6050
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Country | US
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Telephone | 757-705-3082
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Fax | 757-340-0891
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JENNIFER BRAUN BOWERS
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Credential | O.D.
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Telephone | 757-705-3082
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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 | 0618001612
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License Number State | VA
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