MEDICARE: NATIONAL OPTOMETRY STEVEN KASINOF AND 17 ASSOCIATES OPTOMETRISTS

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	0603000171	VA

General Provider Information

NPI Number	:	1902086473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL OPTOMETRY STEVEN KASINOF AND 17 ASSOCIATES OPTOMETRISTS

Provider Business Mailing Address
First Line	:	1255 FORDHAM DR
Second Line	:	STE. 114
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5347
Country	:	US
Telephone Number	:	757-523-0161
Fax Number	:	757-523-0289

Provider Business Practice Location Address
First Line	:	1255 FORDHAM DR
Second Line	:	STE. 114
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5347
Country	:	US
Telephone Number	:	757-523-0161
Fax Number	:	757-523-0289

Authorized Official
Title or Position	:	O.D. / MANAGING MEMBER
Name	:	DR. JAMES J WHITELOCK
Credential	:	O.D.
Telephone Number	:	717-263-2389

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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