MEDICARE: DR. JOSHUA FOREST SHOWS 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	0618001166	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103407	OTHER	VA	ANTHEM BC/BS ID

General Provider Information

NPI Number	:	1750386785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA FOREST SHOWS O.D.

Provider Business Mailing Address
First Line	:	1770 N PARHAM RD STE 101
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23229-4658
Country	:	US
Telephone Number	:	804-935-7700
Fax Number	:	804-794-9216

Provider Business Practice Location Address
First Line	:	1770 N PARHAM RD STE 101
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23229-4658
Country	:	US
Telephone Number	:	804-935-7700
Fax Number	:	804-935-7704

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/14/2019

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