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NPI Code Detail

MEDICARE: RIVERSIDE PHYSICIAN SERVICES INC

MEDICARE: RIVERSIDE PHYSICIAN SERVICES INC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1962425884
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE PHYSICIAN SERVICES INC
Provider Business Mailing Address
First Line : 4032 CAMPBELL RD
Second Line : SUITE B
City : NEWPORT NEWS
State : VA
Zip : 23602-4518
Country : US
Telephone Number : 757-877-3956
Fax Number : 757-856-7121
Provider Business Practice Location Address
First Line : 4032 CAMPBELL RD
Second Line : SUITE B
City : NEWPORT NEWS
State : VA
Zip : 23602-4252
Country : US
Telephone Number : 757-877-3956
Fax Number : 757-856-7121
Authorized Official
Title or Position : VICE PRESIDENT
Name : JAMES LESNICK
Credential :
Telephone Number : 757-594-4006
Provider Enumeration Date : 07/25/2006
Last Update Date : 02/21/2011

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Directions to “RIVERSIDE PHYSICIAN SERVICES INC ” Practice Location

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