MEDICARE: DR. PETER G. NARDONE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618000098	VA

General Provider Information

NPI Number	:	1215928866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER G. NARDONE O.D.

Provider Business Mailing Address
First Line	:	5419 PATTERSON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2003
Country	:	US
Telephone Number	:	804-285-7638
Fax Number	:	804-285-2107

Provider Business Practice Location Address
First Line	:	5419 PATTERSON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2003
Country	:	US
Telephone Number	:	804-285-7638
Fax Number	:	804-285-2107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	10/23/2007

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