=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891323101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARPVUE EYECARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2020
-----------------------------------------------------
Last Update Date | 03/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15243 FOREST RD STE E
-----------------------------------------------------
City | FOREST
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24551-4974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-525-2830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15243 FOREST RD STE E
-----------------------------------------------------
City | FOREST
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24551-4974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-525-2830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | ANNA H FAROUQ
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 704-277-6755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------