Provider Demographics
NPI:1073539490
Name:DRS RECORD & RECORD OPTOMETRISTS PC
Entity Type:Organization
Organization Name:DRS RECORD & RECORD OPTOMETRISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RECORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-978-4090
Mailing Address - Street 1:600 PETER JEFFERSON PKWY
Mailing Address - Street 2:SUITE 390
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8835
Mailing Address - Country:US
Mailing Address - Phone:434-975-2420
Mailing Address - Fax:434-979-0500
Practice Address - Street 1:600 PETER JEFFERSON PKWY
Practice Address - Street 2:SUITE 390
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8835
Practice Address - Country:US
Practice Address - Phone:434-975-2420
Practice Address - Fax:434-979-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05278Medicare UPIN