Provider Demographics
NPI:1083088082
Name:SINGLETON, GUS JR (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:GUS
Middle Name:
Last Name:SINGLETON
Suffix:JR
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CRANE CIR
Mailing Address - Street 2:APT M
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-5122
Mailing Address - Country:US
Mailing Address - Phone:757-746-5983
Mailing Address - Fax:
Practice Address - Street 1:22 RESEARCH DR
Practice Address - Street 2:SUITE 115
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1787
Practice Address - Country:US
Practice Address - Phone:757-746-5983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-14
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004032156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician