MEDICARE: DRS. DEVITO & MARTIN OD

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

General Provider Information

NPI Number	:	1689908493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. DEVITO & MARTIN OD

Provider Business Mailing Address
First Line	:	5900 E VIRGINIA BEACH BLVD
Second Line	:	125 JANAF SHOPPING CENTER
City	:	NORFOLK
State	:	VA
Zip	:	23502-2473
Country	:	US
Telephone Number	:	757-461-3101
Fax Number	:	757-461-6942

Provider Business Practice Location Address
First Line	:	5900 E VIRGINIA BEACH BLVD
Second Line	:	125 JANAF SHOPPING CENTER
City	:	NORFOLK
State	:	VA
Zip	:	23502-2473
Country	:	US
Telephone Number	:	757-461-3101
Fax Number	:	757-461-6942

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	KURT K DEVITO
Credential	:	O.D.
Telephone Number	:	757-461-3101

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	05/19/2010

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