Provider Demographics
NPI:1083826259
Name:AMANDA COLLEEN PAULL
Entity Type:Organization
Organization Name:AMANDA COLLEEN PAULL
Other - Org Name:COMPASSIONATE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAULL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-263-7845
Mailing Address - Street 1:STONY POINT FASHION PARK
Mailing Address - Street 2:9200 STONY POINT PARKWAY, STE 195B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-263-7845
Mailing Address - Fax:804-335-1310
Practice Address - Street 1:STONY POINT FASHION PARK
Practice Address - Street 2:9200 STONY POINT PARKWAY, STE 195B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-263-7845
Practice Address - Fax:804-335-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10162Medicare PIN