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General NPI Number Information
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NPI Number | 1841352481
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE EYE CENTER PC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 1511 W THIRD ST
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-392-9555
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Fax | 434-392-1524
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Provider Business Mailing Address
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Address Line | PO BOX 506
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City | FARMVILLE
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State | VA
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Zip | 23901-0506
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Country | US
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Telephone | 434-392-9555
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Fax | 434-392-1524
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. RIPON W LAROCHE II
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Credential | MD
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Telephone | 434-392-9555
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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 | 0101033222
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License Number State | VA
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