| NPI | 1659696391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY L REYNOLDS Insurance Representative 757-595-8404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101041607) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000430) |
| 152W00000X Optometrist (Licence: VA 0618001144) | |
| 152W00000X Optometrist (Licence: VA 0618001735) | |
| 207W00000X Ophthalmology (Licence: VA 0101056628) | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2010-04-06 |