MEDICARE: EARL M POLLOCK 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	0618000197	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427033174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL M POLLOCK O.D.

Provider Business Mailing Address
First Line	:	3282 WESTERN BRANCH BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5261
Country	:	US
Telephone Number	:	757-484-8080
Fax Number	:	757-483-6310

Provider Business Practice Location Address
First Line	:	3282 WESTERN BRANCH BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5261
Country	:	US
Telephone Number	:	757-484-8080
Fax Number	:	757-483-6310

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	10/20/2010

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