Provider Demographics
NPI:1073545539
Name:EYECARE SALEM, INC
Entity Type:Organization
Organization Name:EYECARE SALEM, INC
Other - Org Name:INVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURACE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHITWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-387-1183
Mailing Address - Street 1:115 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4907
Mailing Address - Country:US
Mailing Address - Phone:540-387-1183
Mailing Address - Fax:
Practice Address - Street 1:115 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4907
Practice Address - Country:US
Practice Address - Phone:540-387-1183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
461360OtherANTHEM
VA4715110001Medicare NSC
461360OtherANTHEM