Provider Demographics
NPI:1053458000
Name:ENOCHS EYE CARE PLLC
Entity Type:Organization
Organization Name:ENOCHS EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ENOCHS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-638-2015
Mailing Address - Street 1:3575 BRIDGE RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1805
Mailing Address - Country:US
Mailing Address - Phone:757-638-2015
Mailing Address - Fax:757-638-2010
Practice Address - Street 1:3575 BRIDGE RD
Practice Address - Street 2:SUITE 21
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1805
Practice Address - Country:US
Practice Address - Phone:757-638-2015
Practice Address - Fax:757-638-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09968Medicare PIN